Division of Emergency Medicine, Department of Pediatrics, Nemours Children's Hospital Delaware, Wilmington, DE, USA.
Division of Emergency Medicine, Department of Pediatrics, Nemours Children's Hospital Delaware, Wilmington, DE, USA.
Am J Emerg Med. 2022 Jul;57:76-80. doi: 10.1016/j.ajem.2022.04.021. Epub 2022 Apr 26.
Vital signs (VS) are used to triage and identify children at risk for severe illness. Few studies have examined the association of pediatric VS at emergency department (ED) discharge with patient outcomes.
To determine if children discharged from the ED with abnormal VS have high rates of return visits, admission or adverse outcomes.
We conducted a retrospective cohort study of children discharged from 2 pediatric EDs with abnormal VS between July 2018-June 2019. We queried electronic health records (EHR) for children ages 0-18 years discharged from the ED with abnormal last recorded VS. VS were considered erroneously entered and thus excluded from analysis if heart rate was <30 or ≥ 300, respiratory rate was 0 or ≥ 100 or oxygen saturation was <50. Patients who were declared deceased at index visit were excluded. Demographic, clinical, and outcome data including return visits within 48 h and adverse outcomes after the initial ED discharge were obtained.
Of the 97,824 children evaluated in the EDs during the study period, 17,661 (18.1%) were discharged with abnormal VS. 404 (2.28%) returned to the ED, of which 95 (23.5%) were admitted for the same chief complaint within 48 h. In comparison, the 48-h return rate for children discharged with normal VS was 2.45% (p = 0.219). Children discharged with abnormal VS were more likely to return if they had 2 or more abnormal VS (OR 1.6; 95% CI 1.23-2.07), were less than 3 years old (OR 1.69, 95% CI 1.39-2.06) or their initial acuity level was high (OR 1.34; 95% CI 1.1-1.63). Higher initial acuity level and age less than 3 years were also associated with admission at revisit (OR 2.58; 95% CI 1.59-4.2; OR 2.20, 95% CI 1.36-3.55). Four of the children who returned required PICU admission, but none died, required CPR or endotracheal intubation.
Although many children were discharged from the ED with abnormal VS, few returned and required admission. Having 2 or more abnormal VS, age less than 3 years and higher acuity increased odds of revisit. Few children suffered serious adverse outcomes.
生命体征（VS）用于分诊和识别有患病风险的儿童。很少有研究探讨儿科急诊科（ED）出院时 VS 异常与患者结局之间的关系。
确定从 ED 出院时 VS 异常的儿童是否有高比例的复诊、住院或不良结局。
我们对 2018 年 7 月至 2019 年 6 月期间从 2 家儿科 ED 出院的 VS 异常的儿童进行了回顾性队列研究。我们通过电子健康记录（EHR）查询了 ED 出院时 VS 最后一次记录异常的 0-18 岁儿童。如果心率<30 或≥300、呼吸频率为 0 或≥100 或血氧饱和度<50，则认为 VS 被错误输入，因此将其排除在分析之外。在指数就诊时被宣布死亡的患者被排除在外。获得了人口统计学、临床和结局数据，包括 48 小时内复诊和初始 ED 出院后的不良结局。
在研究期间，在 ED 接受评估的 97824 名儿童中，有 17661 名（18.1%）出院时 VS 异常。其中 404 名（2.28%）返回 ED，其中 95 名（23.5%）在 48 小时内因相同主诉住院。相比之下，出院时 VS 正常的儿童 48 小时复诊率为 2.45%（p=0.219）。如果儿童有 2 项或更多 VS 异常（OR 1.6；95%CI 1.23-2.07）、年龄小于 3 岁（OR 1.69，95%CI 1.39-2.06）或初始严重程度高（OR 1.34；95%CI 1.1-1.63），则更有可能返回 ED。初始严重程度较高和年龄小于 3 岁也与复诊时入院有关（OR 2.58；95%CI 1.59-4.2；OR 2.20，95%CI 1.36-3.55）。返回的 4 名儿童中需要进入 PICU，但均未死亡，需要心肺复苏或气管插管。
尽管许多儿童从 ED 出院时 VS 异常，但很少有儿童返回并需要住院。有 2 项或更多 VS 异常、年龄小于 3 岁和较高的严重程度增加了复诊的几率。很少有儿童出现严重不良结局。
