Division of Emergency Medicine (B Kappy, K Edmunds, M Frey, Y Zhang, S Boyd, WJ Pomerantz, and B Kerrey), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Emergency Medicine (B Kappy, K Edmunds, M Frey, Y Zhang, S Boyd, WJ Pomerantz, and B Kerrey), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (K Edmunds, WJ Pomerantz, B Kerrey and S Hanke), University of Cincinnati College of Medicine, Cincinnati, Ohio.
Acad Pediatr. 2022 Aug;22(6):1065-1072. doi: 10.1016/j.acap.2022.03.009. Epub 2022 Mar 18.
Unsafe sleep remains a leading cause of preventable sudden unexpected infant death (SUID). Infants frequently visit emergency departments (EDs), but the frequency of visits before SUID is unknown. The objective of this study was to determine how often SUID infants visited a pediatric ED or urgent care (UC) before death.
We performed a retrospective study of infant deaths in the county of a large, academic pediatric institution. We linked institutional records with coroner reports and death scene investigations. We excluded deaths associated with childbirth, prematurity, injury, or underlying medical condition. We characterized all SUID infants, focusing on unsafe sleep factors detailed in the medical record and scene reports. The main outcome was ED/UC visit(s) before the visit for SUID.
Seventy-three of 122 infant deaths met inclusion criteria for SUID over 76 months (April 2014-July 2020). Median age at death was 87 days (IQR 58, 137); 68 (93%) died before 6 months-of-age. Twenty infants (27%) had an ED/UC visit before SUID; mean visits for these infants were 1.7 (SD 0.8). Median days between the last ED/UC visit and SUID was 39; five infants visited the ED/UC within 2 weeks of SUID. Most visits were for minor medical conditions. All 73 SUID infants had at least one unsafe sleep factor; 88% had ≥2 and 56% ≥3.
Many SUID infants visited a pediatric ED/UC before death, and unsafe sleep factors were found in every case. Early infancy ED/UC visits may present an opportunity for targeted prevention efforts.
不安全的睡眠仍然是可预防的婴儿猝死（SUID）的主要原因。婴儿经常去急诊部（ED）就诊，但在 SUID 之前的就诊频率尚不清楚。本研究的目的是确定 SUID 婴儿在死亡前多久会去儿科 ED 或紧急护理（UC）就诊。
我们对一家大型学术儿科机构所在县的婴儿死亡进行了回顾性研究。我们将机构记录与验尸官报告和死亡现场调查联系起来。我们排除了与分娩、早产、伤害或潜在医疗状况相关的死亡。我们对所有 SUID 婴儿进行了特征描述，重点关注病历和现场报告中详细描述的不安全睡眠因素。主要结局是 SUID 就诊前的 ED/UC 就诊次数。
在 76 个月（2014 年 4 月至 2020 年 7 月）期间，有 122 例婴儿死亡符合 SUID 的纳入标准。死亡时的中位年龄为 87 天（IQR 58, 137）；68 例（93%）在 6 个月之前死亡。20 例婴儿（27%）在 SUID 之前有 ED/UC 就诊；这些婴儿的平均就诊次数为 1.7（SD 0.8）。从最后一次 ED/UC 就诊到 SUID 的中位时间为 39 天；5 例婴儿在 SUID 发生前 2 周内就诊过 ED/UC。大多数就诊是为了治疗轻微的医疗状况。所有 73 例 SUID 婴儿都至少有一个不安全睡眠因素；88%有≥2 个，56%有≥3 个。
许多 SUID 婴儿在死亡前曾去过儿科 ED/UC，而且在每个病例中都发现了不安全的睡眠因素。婴儿早期的 ED/UC 就诊可能为有针对性的预防措施提供了机会。
