用于筛查术前发热儿科患者的鼻咽多重聚合酶链反应系统的效用。
The usefulness of a nasopharyngeal multiplex polymerase chain reaction system to screen pediatric patients with preoperative fever.
机构信息
Department of Anesthesiology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan.
Division of Infectious Diseases, Department of Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan.
出版信息
Acta Anaesthesiol Scand. 2023 Jul;67(6):724-729. doi: 10.1111/aas.14226. Epub 2023 Mar 14.
BACKGROUND
When children have a preoperative fever, anesthesiologists must help determine whether to postpone or proceed with surgery, as fever may be a sign of upper respiratory tract infection (URTI). Such infections are a known risk factor for perioperative respiratory adverse events (PRAEs), which are still one of the prime causes of anesthetic mortality and morbidity in pediatric patients. Since the COVID-19 pandemic, preoperative assessments have become drastically more complex as hospitals strive to balance practicality and safety. In our facility, if pediatric patients presented with preoperative fever, we used the FilmArray® Respiratory Panel 2.1 to determine whether to postpone or proceed with surgery.
METHODS
This is a single-center retrospective observational study evaluating the efficacy of the FilmArray® Respiratory Panel 2.1 as a preoperative screening test. This study included pediatric patients scheduled for elective surgeries between March 2021 and February 2022. FilmArray was used if a patient had a preoperative fever (determined by axillary temperature, ≥38°C for <1-year-old, ≥37.5°C for ≥1-year-old) between hospital admission and before surgery. We excluded patients if they had apparent symptoms of URTI.
RESULTS
In the FilmArray positive group, 11 of 25 (44%) cases developed subsequent symptoms after surgery was canceled. No patients in the negative group developed symptoms. The proportion of the development of subsequent symptoms between the FilmArray positive and negative groups was statistically significant (p < .001, odds ratio: 29.6, 95% confidence interval: [3.80-1356.01]).
CONCLUSIONS
Our retrospective observational study revealed that 44% of the FilmArray positive group subsequently developed symptoms, and no PRAEs were observed in the FilmArray negative group. We suggest that FilmArray could be useful as a screening test for pediatric patients with preoperative fever.
背景
当儿童出现术前发热时，麻醉师必须帮助确定是否推迟或进行手术，因为发热可能是上呼吸道感染 (URTI) 的迹象。此类感染是围手术期呼吸不良事件 (PRAE) 的已知危险因素，这仍然是小儿患者麻醉死亡率和发病率的主要原因之一。自 COVID-19 大流行以来，由于医院努力平衡实用性和安全性，术前评估变得更加复杂。在我们的机构中，如果小儿患者出现术前发热，我们使用 FilmArray®Respiratory Panel 2.1 来确定是否推迟或进行手术。
方法
这是一项单中心回顾性观察研究，评估 FilmArray®Respiratory Panel 2.1 作为术前筛查试验的功效。本研究纳入了 2021 年 3 月至 2022 年 2 月期间择期手术的儿科患者。如果患者在住院期间至手术前腋温≥38°C（<1 岁）或≥37.5°C（≥1 岁）出现术前发热，则使用 FilmArray。如果患者有明显的 URTI 症状，则将其排除在外。
结果
在 FilmArray 阳性组中，25 例中有 11 例（44%）在手术取消后出现了后续症状。阴性组中没有患者出现症状。FilmArray 阳性组和阴性组之间出现后续症状的比例具有统计学意义（p<0.001，优势比：29.6，95%置信区间：[3.80-1356.01]）。
结论
我们的回顾性观察研究显示，44%的 FilmArray 阳性组随后出现症状，而 FilmArray 阴性组未观察到 PRAE。我们建议 FilmArray 可作为术前发热的小儿患者的一种筛查试验。
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