Department of Emergency Medicine, Emory Healthcare Network, Atlanta, Georgia, USA.
Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
J Glob Health. 2023 Jun 9;13:04065. doi: 10.7189/jogh.13.04065.
Severe acute respiratory infections (SARIs) are the leading cause of paediatric death globally, particularly in low- and middle-income countries (LMICs). Given the potential rapid clinical decompensation and high mortality rate from SARIs, interventions that facilitate the early care are critical to improving patient outcomes. Through this systematic review, we aimed to evaluate the impact of emergency care interventions on improving clinical outcomes of paediatric patients with SARIs in LMICs.
We searched PubMed, Global Health, and Global Index Medicus for peer-reviewed clinical trials or studies with comparator groups published before November 2020. We included all studies which evaluated acute and emergency care interventions on clinical outcomes for children (29 days to 19 years) with SARIs conducted in LMICs. Due to observed heterogeneity of interventions and outcomes, we performed narrative synthesis. We assessed bias using the Risk of Bias 2 and Risk of Bias in Non-Randomized Studies of Interventions tools.
We screened 20 583, 99 of which met the inclusion criteria. Conditions studied included pneumonia or acute lower respiratory infection (61.6%) and bronchiolitis (29.3%). Studies evaluated medications (80.8%), respiratory support (14.1%), and supportive care (5%). We found the strongest evidence of benefit for decreasing risk of death for respiratory support interventions. Results were inconclusive on the utility of continuous positive airway pressure (CPAP). We found mixed results for interventions for bronchiolitis, but a possible benefit for hypertonic nebulised saline to decrease hospital length of stay. Early use of adjuvant treatments such as Vitamin A, D, and zinc for pneumonia and bronchiolitis did not appear to have convincing evidence of benefit on clinical outcomes.
Despite the high global burden of SARI in paediatric populations, few emergency care (EC) interventions have high quality evidence for benefit on clinical outcomes in LMICs. Respiratory support interventions have the strongest evidence for benefit. Further research on the use of CPAP in diverse settings is needed, as is a stronger evidence base for EC interventions for children with SARI, including metrics on the timing of interventions.
PROSPERO (CRD42020216117).
严重急性呼吸道感染（SARI）是全球儿童死亡的主要原因，尤其是在中低收入国家（LMICs）。鉴于 SARI 可能导致迅速的临床恶化和高死亡率，促进早期治疗的干预措施对于改善患者预后至关重要。通过这项系统评价，我们旨在评估紧急护理干预措施对改善 LMICs 中患有 SARI 的儿科患者临床结局的影响。
我们在 PubMed、全球卫生和全球索引医学中检索了截至 2020 年 11 月发表的具有对照组的同行评审临床试验或研究。我们纳入了所有评估急性和紧急护理干预措施对 LMICs 中患有 SARI 的儿童（29 天至 19 岁）临床结局的研究。由于干预措施和结局的异质性，我们进行了叙述性综合分析。我们使用风险偏倚 2 和干预措施的非随机研究风险偏倚工具评估偏倚。
我们筛选了 20583 篇文章，其中 99 篇符合纳入标准。研究的疾病包括肺炎或急性下呼吸道感染（61.6%）和细支气管炎（29.3%）。研究评估了药物（80.8%）、呼吸支持（14.1%）和支持性护理（5%）。我们发现呼吸支持干预措施降低死亡风险的证据最强。对于持续气道正压通气（CPAP）的效果，结果不确定。对于细支气管炎的干预措施，结果存在差异，但高渗盐水雾化吸入可能有助于缩短住院时间。对于肺炎和细支气管炎，早期使用辅助治疗如维生素 A、D 和锌似乎没有令人信服的证据表明对临床结局有益。
尽管 SARI 在儿科人群中的全球负担很高，但在 LMICs 中，很少有紧急护理（EC）干预措施具有高质量的临床结局获益证据。呼吸支持干预措施具有最强的获益证据。需要进一步研究 CPAP 在不同环境中的应用，以及针对 SARI 患儿的 EC 干预措施的更强证据基础，包括干预时间的指标。
PROSPERO（CRD42020216117）。
