急诊科对儿科患者的准备情况与儿童死亡率：一项系统评价
Readiness of emergency departments for pediatric patients and pediatric mortality: a systematic review.
作者信息
Harper Jessica A, Coyle Amanda C, Tam Clara, Skakum Megan, Ragheb Mirna, Wilson Lucy, Lê Mê-Linh, Klassen Terry P, Aregbesola Alex
机构信息
Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man.
出版信息
CMAJ Open. 2023 Oct 17;11(5):E956-E968. doi: 10.9778/cmajo.20210337. Print 2023 Sep-Oct.
BACKGROUND
Most children who need emergency care visit general emergency departments and urgent care centres; the weighted pediatric readiness score (WPRS) is currently used to evaluate emergency departments' readiness for pediatric patients. The aim of this study was to determine whether a higher WPRS was associated with decreased mortality and improved health care outcomes and utilization.
METHODS
We conducted a systematic review of cohort and cross-sectional studies on emergency departments that care for children (age ≤ 21 yr). We searched MEDLINE (Ovid), Embase (Ovid), the Cochrane Library (Wiley), CINAHL (EBSCO), Global Health (Ovid) and Scopus from inception until July 29, 2022. Articles identified were screened for inclusion by 2 independent reviewers. The primary outcome was mortality, and the secondary outcomes were health care outcomes and utilization. We used the Newcastle-Ottawa Scale to assess for quality and bias of the included studies. The statistic was calculated to quantify study heterogeneity.
RESULTS
We identified 1789 articles. Eight articles were included in the final analysis. Three studies showed an inverse association between highest WPRS quartile and pediatric mortality (pooled odds ratio [OR] 0.45, 95% confidence interval [CI] 0.26 to 0.78; = 89%, low certainty of evidence) in random-effects meta-analysis. Likewise, 1 study not included in the meta-analysis also reported an inverse association with a 1-point increase in WPRS (OR 0.93, 95% CI 0.88 to 0.98). One study reported that the highest WPRS quartile was associated with shorter length of stay in hospital (β -0.36 days, 95% CI -0.61 to -0.10). Three studies concluded that the highest WPRS quartile was associated with fewer interfacility transfers. The certainty of evidence is low for mortality and moderate for the studied health care outcomes and utilization.
INTERPRETATION
The data suggest a potential inverse association between the WPRS of emergency departments and mortality risk in children. More studies are needed to refute or confirm these findings.
PROTOCOL REGISTRATION
PROSPERO-CRD42020191149.
背景
大多数需要急诊护理的儿童会前往综合急诊科和紧急护理中心；目前使用加权儿科准备就绪评分（WPRS）来评估急诊科对儿科患者的准备情况。本研究的目的是确定较高的WPRS是否与死亡率降低、医疗保健结果改善及利用率提高相关。
方法
我们对为儿童（年龄≤21岁）提供护理的急诊科的队列研究和横断面研究进行了系统评价。我们检索了MEDLINE（Ovid）、Embase（Ovid）、Cochrane图书馆（Wiley）、CINAHL（EBSCO）、全球健康（Ovid）和Scopus数据库，检索时间从各数据库建库至2022年7月29日。由2名独立评审员筛选确定纳入的文章。主要结局为死亡率，次要结局为医疗保健结果和利用率。我们使用纽卡斯尔-渥太华量表评估纳入研究的质量和偏倚。计算统计量以量化研究异质性。
结果
我们共识别出1789篇文章。最终分析纳入了8篇文章。3项研究在随机效应荟萃分析中显示，WPRS最高四分位数与儿科死亡率之间存在负相关（合并比值比[OR]0.45，95%置信区间[CI]0.26至0.78；I² = 89%，证据确定性低）。同样，1项未纳入荟萃分析的研究也报告称，WPRS每增加1分存在负相关（OR 0.93，95% CI 0.88至0.98）。1项研究报告称，WPRS最高四分位数与住院时间缩短相关（β -0.36天，95% CI -0.61至-0.10）。3项研究得出结论，WPRS最高四分位数与机构间转运减少相关。死亡率的证据确定性低，所研究的医疗保健结果和利用率的证据确定性为中等。
解读
数据表明急诊科的WPRS与儿童死亡风险之间可能存在负相关。需要更多研究来反驳或证实这些发现。
方案注册
PROSPERO-CRD42020191149
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