Department of Pediatrics, University of Ottawa, Ottawa, Canada.
Department of Pediatrics, University of Alberta, Edmonton, Canada.
PLoS One. 2022 Jul 28;17(7):e0272154. doi: 10.1371/journal.pone.0272154. eCollection 2022.
The incidence of hospitalizations for acute respiratory infections (ARI) among young Indigenous children from Northern Canada is consistently high. ARIs requiring urgent air transfer can be life-threatening and costly. We aimed to describe their epidemiology, estimate age-specific incidences, and explore factors associated with level of care required.
We undertook a retrospective cohort study of children <5 years old from Northern Canada transferred by urgent air transport for ARI from 2005 through 2014 to 5 pediatric tertiary care centers in Vancouver, Edmonton, Winnipeg, Ottawa and Montreal. Admissions were identified via ARI-related ICD-9/10 coding and forward sortation area. Descriptive statistics and univariable analyses were performed.
Among 650 urgent air transfers, the majority were from Nunavut (n = 349, 53.7%) or Nunavik (n = 166, 25.5%), <6 months old (n = 372, 57.2%), and without underlying comorbidity (n = 458; 70.5%). Estimated annual tertiary care ARI admission rates in infants <1 year old from Nunavut (40.7/1000) and Nunavik (44.5/1000) were tenfold higher than in children aged 1 to 4 years. Bronchiolitis (n = 333, 51.2%) and pneumonia (n = 208, 32.0%) were the most common primary discharge diagnoses. Nearly half required critical care (n = 316, 48.6%); mechanical ventilation rates ranged from 7.2% to 55.9% across centres. The most common primary pathogen was respiratory syncytial virus (n = 196, 30.1%). Influenza A or B was identified in 35 cases (5.4%) and vaccine-preventable bacterial infections in 27 (4.1%) cases.
Urgent air transfers for ARI from Northern Canada are associated with high acuity. Variations in levels of care were seen across referral centers, age groups and pathogens.
加拿大北部的年轻原住民儿童因急性呼吸道感染（ARI）住院的发生率一直很高。需要紧急空运的ARI 可能危及生命且费用高昂。我们旨在描述其流行病学特征，估计特定年龄的发病率，并探讨与所需护理水平相关的因素。
我们对 2005 年至 2014 年期间通过紧急空运从加拿大北部转运至温哥华、埃德蒙顿、温尼伯、渥太华和蒙特利尔的 5 家儿科三级保健中心的 <5 岁儿童进行了回顾性队列研究。通过 ARI 相关的 ICD-9/10 编码和正向排序区识别入院。进行描述性统计和单变量分析。
在 650 次紧急空运中，大多数来自努纳武特（n = 349，53.7%）或努纳维克（n = 166，25.5%），<6 个月大（n = 372，57.2%），且无潜在合并症（n = 458；70.5%）。来自努纳武特（40.7/1000）和努纳维克（44.5/1000）的<1 岁婴儿的年度三级保健 ARI 入院率估计是 1 至 4 岁儿童的 10 倍。细支气管炎（n = 333，51.2%）和肺炎（n = 208，32.0%）是最常见的主要出院诊断。近一半需要重症监护（n = 316，48.6%）；各中心的机械通气率范围为 7.2%至 55.9%。最常见的主要病原体是呼吸道合胞病毒（n = 196，30.1%）。甲型或乙型流感在 35 例（5.4%）中得到确认，27 例（4.1%）为可通过疫苗预防的细菌感染。
来自加拿大北部的 ARI 紧急空运与高发病率相关。不同转诊中心、年龄组和病原体的护理水平存在差异。
