Nkoy Flory, Stone Bryan, Sheng Xiaoming, Murphy Nancy
University of Utah, Department of Pediatrics, Salt Lake City, Utah.
Hosp Pediatr. 2023 Mar 1;13(3):250-257. doi: 10.1542/hpeds.2022-006876.
High concern about child's health is a common reason parents of children with medical complexity (CMC) seek care in emergency departments and hospitals. Factors driving parental concern are unknown. This study explores associations of parent's sociodemographic and child's clinical factors with high parental concern.
Secondary analysis of a pilot study of CMC and parents who used daily for 3 months MyChildCMC, a home monitoring app. Parents recorded their child's vital signs (temperature, heart rate, respiratory rate, oximetry), symptoms (pain, seizures, fluid intake/feeding, mental status), and oxygen use, and received immediate feedback. Parents rated their child's health concern on a 4-point Likert scale. Concern scores were dichotomized (3-4 = high, 1-2 = low) and modeled in a mixed-effects logistic regression to explore important associations.
We analyzed 1223 measurements from 24 CMC/parents, with 113 (9.24%) instances of high concern. Child factors associated with high parental concern were increased pain (odds ratio [OR], 5.10; 95% confidence interval [CI], 2.53-10.29; P < .01), increased oxygen requirement (OR, 28.91; 95% CI, 10.07-82.96; P < .01), reduced nutrition/fluid intake (OR, 71.58; 95% CI, 13.01-393.80; P < .01), and worsened mental status (OR, 2.15; 95% CI, 1.10-4.17, P = .02). No other associations existed.
Changes in CMC's clinical parameters were associated with high concern, which may be an early indicator of acute illness in CMC when it is the primary complaint. Monitoring and responding to high parental concerns may support CMC care at home.
对儿童健康的高度关注是患有复杂疾病儿童（CMC）的父母在急诊科和医院寻求治疗的常见原因。导致父母担忧的因素尚不清楚。本研究探讨父母的社会人口统计学因素和儿童的临床因素与父母高度担忧之间的关联。
对一项针对CMC及其父母的试点研究进行二次分析，这些父母连续3个月每天使用家庭监测应用程序MyChildCMC。父母记录孩子的生命体征（体温、心率、呼吸频率、血氧饱和度）、症状（疼痛、癫痫发作、液体摄入量/喂养情况、精神状态）以及氧气使用情况，并获得即时反馈。父母用4点李克特量表对孩子的健康担忧程度进行评分。将担忧得分分为两类（3 - 4分为高，1 - 2分为低），并通过混合效应逻辑回归模型来探究重要的关联。
我们分析了来自24对CMC/父母的1223次测量数据，其中有113次（9.24%）出现高度担忧的情况。与父母高度担忧相关的儿童因素包括疼痛加剧（优势比[OR]，5.10；95%置信区间[CI]，2.53 - 10.29；P <.01）、氧气需求增加（OR，28.91；95% CI，10.0
