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急诊科镰状细胞病儿科患者发热的原因及建议:一项单中心研究

Causes and Recommendations for Fever in Sickle Cell Pediatric Patients in the Emergency Department: A Single-Center Study.

作者信息

Halwani Manal A

机构信息

Pediatric Emergency, King Abdulaziz University Hospital, Jeddah, SAU.

出版信息

Cureus. 2023 Sep 9;15(9):e44959. doi: 10.7759/cureus.44959. eCollection 2023 Sep.

DOI:10.7759/cureus.44959
PMID:37818503
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10561955/
Abstract

Background Children with sickle cell disease (SCD) are prone to bacterial infections, culminating in life-threatening incidences. Early evaluation of children with SCD helps in effective management and support. Methodology A retrospective study was conducted using medical records for febrile episodes in SCD children ≤14 years of age who presented to the Emergency Department of King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia from 2015 to 2018. A total of 304 episodes were encountered in the Emergency Department during this period. Results The clinical diagnosis included confirmed bacterial infection (4.5%), presumed bacterial infection (24.6%), and those without bacterial infection (57.5%). The incidence of bacteremia was found in 3.0% of the episodes and urinary tract infection in 1.5%. The most common isolates were , , species, and . Overall, 52% of the febrile episodes resulted in hospitalization, of which 74% had at least one prior hospitalization. The hospitalization probability across the two sexes was statistically insignificant (p = 0.029). The likelihood of admission increased with age (p < 0.001) and temperature (p < 0.001). The study included 140 children with SCD who had at least one abdominal sonogram performed at our hospital between 2015 and 2018. There were changes in the radiographic appearance of the spleen in patients with SCD who were expected to undergo autosplenectomy between the ages of five and 17 years. Conclusions The study envisages the risk associated with febrile episodes and the prompt recovery of such patients through clinical confirmations. Parents should be aware and observant of the complications of infectious illnesses for speedy medical assistance.

摘要

背景

镰状细胞病(SCD)患儿易发生细菌感染,最终可能导致危及生命的情况。对SCD患儿进行早期评估有助于有效管理和支持。

方法

采用回顾性研究,利用2015年至2018年期间在沙特阿拉伯王国吉达阿卜杜勒阿齐兹国王大学医院急诊科就诊的14岁及以下SCD患儿发热发作的病历。在此期间,急诊科共遇到304次发作。

结果

临床诊断包括确诊细菌感染(4.5%)、疑似细菌感染(24.6%)和无细菌感染(57.5%)。在3.0%的发作中发现菌血症,1.5%的发作中发现尿路感染。最常见的分离菌是 、 、 种和 。总体而言,52%的发热发作导致住院,其中74%至少有一次先前住院史。两性之间的住院概率在统计学上无显著差异(p = 0.029)。入院可能性随年龄(p < 0.001)和体温(p < 0.001)增加。该研究纳入了140名SCD患儿,他们在2015年至2018年期间在我院至少进行了一次腹部超声检查。预计在5至17岁之间进行自体脾切除的SCD患者脾脏的影像学表现有变化。

结论

该研究设想了发热发作相关的风险以及通过临床确诊促使此类患者迅速康复。家长应了解并注意感染性疾病的并发症,以便迅速获得医疗帮助。

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本文引用的文献

1
Urinary Tract Infection in Febrile Children with Sickle Cell Disease Who Present to the Emergency Room with Fever.因发热前往急诊室就诊的镰状细胞病发热儿童的尿路感染
J Clin Med. 2020 May 19;9(5):1531. doi: 10.3390/jcm9051531.
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A Quality Initiative to Decrease Time to Antibiotics in Children with Sickle Cell Disease and Fever.一项旨在缩短镰状细胞病合并发热儿童使用抗生素时间的质量改进举措。
Pediatr Qual Saf. 2020 Jan 10;5(1):e245. doi: 10.1097/pq9.0000000000000245. eCollection 2020 Jan-Feb.
3
Fever Management in Sickle Cell Disease in Low- and Middle-Income Countries: A Survey of SCD Management Programs.中低收入国家镰状细胞病的发热管理:镰状细胞病管理项目调查。
Am J Trop Med Hyg. 2020 Apr;102(4):902-904. doi: 10.4269/ajtmh.19-0541.
4
Variation in hospital admission of sickle cell patients from the emergency department using the Pediatric Health Information System.利用儿科健康信息系统观察从急诊入院的镰状细胞病患者的变化。
Pediatr Blood Cancer. 2020 Jun;67(6):e28067. doi: 10.1002/pbc.28067. Epub 2019 Nov 14.
5
Risk of invasive pneumococcal disease in children with sickle cell disease in the era of conjugate vaccines: a systematic review of the literature.疫苗时代镰状细胞病儿童侵袭性肺炎球菌病的风险:文献系统评价。
Br J Haematol. 2019 May;185(4):743-751. doi: 10.1111/bjh.15846. Epub 2019 Mar 11.
6
Practice Variation in Emergency Department Management of Children With Sickle Cell Disease Who Present With Fever.镰状细胞病伴发热儿童在急诊科管理中的实践差异
Pediatr Emerg Care. 2018 Aug;34(8):574-577. doi: 10.1097/PEC.0000000000001569.
7
Expected Sonographic Appearance of the Spleen in Children and Young Adults With Sickle Cell Disease: An Update.镰状细胞病儿童和青年脾脏的预期超声表现:最新进展
J Ultrasound Med. 2016 Aug;35(8):1735-45. doi: 10.7863/ultra.15.09023. Epub 2016 Jun 27.
8
Incidence and Predictors of Bacterial infection in Febrile Children with Sickle Cell Disease.镰状细胞病发热儿童细菌感染的发病率及预测因素
Hemoglobin. 2015;39(5):316-9. doi: 10.3109/03630269.2015.1065419. Epub 2015 Jul 24.
9
Fever in children with sickle cell disease: are all fevers equal?镰状细胞病患儿的发热:所有发热情况都一样吗?
J Emerg Med. 2014 Oct;47(4):395-400. doi: 10.1016/j.jemermed.2014.06.025. Epub 2014 Aug 23.
10
Bacteremia risk and outpatient management of febrile patients with sickle cell disease.发热性镰状细胞病患者的菌血症风险与门诊管理。
Pediatrics. 2013 Jun;131(6):1035-41. doi: 10.1542/peds.2012-2139. Epub 2013 May 13.