von Saint Andre-von Arnim Amelie O, Kumar Rashmi K, Clark Jonna D, Wilfond Benjamin S, Nguyen Quynh-Uyen P, Mutonga Daniel M, Zimmerman Jerry J, Oron Assaf P, Walson Judd L
Division of Pediatric Critical Care, Department of Pediatrics, University of Washington and Seattle Children's, Seattle, WA, United States.
Department of Global Health, University of Washington, Seattle, WA, United States.
Front Pediatr. 2022 May 23;10:804346. doi: 10.3389/fped.2022.804346. eCollection 2022.
Pediatric mortality remains unacceptably high in many low-resource settings, with inpatient deaths often associated with delayed recognition of clinical deterioration. The Family-Assisted Severe Febrile Illness ThERapy (FASTER) tool has been developed for caregivers to assist in monitoring their hospitalized children and alert clinicians. This study evaluates feasibility of implementation by caregivers and clinicians.
Randomized controlled feasibility study at Kenyatta National Hospital, Kenya. Children hospitalized with acute febrile illness with caregivers at the bedside for 24 h were enrolled. Caregivers were trained using the FASTER tool. The primary outcome was the frequency of clinician reassessments between intervention (FASTER) and standard care arms. Poisson regression with random intercept for grouping by patient was used, adjusting for admission pediatric early warning score, age, gender. Secondary outcomes included survey assessments of clinician and caregiver experiences with FASTER.
One hundred and fifty patient/caregiver pairs were enrolled, 139 included in the analysis, 74 in the intervention, 65 in the control arm. Patients' median age was 0.9 (range 0.2-10) and 1.1 years (range 0.2-12) in intervention vs. control arms. The most common diagnoses were pneumonia (80[58%]), meningitis (58[38%]) and malaria (34 [24%]). 134 (96%) caregivers were patients' mothers. Clinician visits/hour increased with patients' illness severity in both arms, but without difference in frequency between arms (point estimate for difference -0.9%, = 0.97). Of the 16 deaths, 8 (four/arm) occurred within 2 days of enrollment. Forty clinicians were surveyed, 33 (82%) reporting that FASTER could improve outcomes of very sick children in low-resource settings; 26 (65%) rating caregivers as able to adequately capture patients' severity of illness. Of 70 caregivers surveyed, 63 (90%) reported that FASTER training was easy to understand; all (100%) agreed that the intervention would improve care of hospitalized children and help identify sick children in their community.
We observed no difference in recorded frequency of clinician visits with FASTER monitoring. However, the tool was rated positively by caregivers and clinicians., Implementation appears feasible but requires optimization. These feasibility data may inform a larger trial powered to measure morbidity and mortality outcomes to determine the utility of FASTER in detecting and responding to clinical deterioration in low-resource settings.
ClinicalTrials.gov, identifier: NCT03513861.
在许多资源匮乏地区，儿科死亡率仍然高得令人无法接受，住院死亡往往与临床病情恶化的识别延迟有关。已开发出家庭辅助重症发热疾病治疗（FASTER）工具，供护理人员协助监测住院儿童并提醒临床医生。本研究评估护理人员和临床医生实施该工具的可行性。
在肯尼亚肯雅塔国家医院进行随机对照可行性研究。纳入因急性发热疾病住院且护理人员在床边陪伴24小时的儿童。使用FASTER工具对护理人员进行培训。主要结局是干预组（FASTER）和标准护理组之间临床医生重新评估的频率。采用患者分组的随机截距泊松回归分析，并对入院时的儿科早期预警评分、年龄、性别进行校正。次要结局包括对临床医生和护理人员使用FASTER的体验进行调查评估。
共纳入150对患者/护理人员，139对纳入分析，干预组74对，对照组65对。干预组和对照组患者的中位年龄分别为0.9岁（范围0.2 - 10岁）和1.1岁（范围0.2 - 12岁）。最常见的诊断为肺炎（80例[58%]）、脑膜炎（58例[38%]）和疟疾（34例[24%]）。134名（96%）护理人员为患者母亲。两组中临床医生的访视频率均随患者病情严重程度增加，但两组之间的频率无差异（差异点估计值为 - 0.9%，P = 0.97）。16例死亡病例中，8例（每组4例）在入组后2天内发生。对40名临床医生进行了调查，33名（82%）报告FASTER可改善资源匮乏地区重病儿童的结局；26名（65%）认为护理人员能够充分掌握患者的病情严重程度。在70名接受调查的护理人员中，63名（90%）报告FASTER培训易于理解；所有（100%）均同意该干预措施可改善住院儿童的护理，并有助于识别社区中的患病儿童。
我们观察到在FASTER监测下记录的临床医生访视频率无差异。然而，护理人员和临床医生对该工具的评价较高。实施似乎可行，但需要优化。这些可行性数据可为一项更大规模的试验提供参考，该试验旨在测量发病率和死亡率结局，以确定FASTER在资源匮乏地区检测和应对临床病情恶化方面的效用。
ClinicalTrials.gov，标识符：NCT03513861。
