Barter Kelsey M, Fuchs Catherine, Graham Thomas B, Pagano Lindsay M, Vater McKenzie
Division of Pediatric and Developmental Neurology, Department of Neurology (KMB), Washington University School of Medicine in St. Louis, MO; Division of Child and Adolescent Psychiatry (CF), Departments of Psychiatry and Behavioral Sciences and Pediatrics; Division of Pediatric Rheumatology (TBG); Division of Pediatric Neurology (LMP); and Division of Pediatric Rheumatology (MV), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
Neurol Clin Pract. 2024 Feb;14(1):e200218. doi: 10.1212/CPJ.0000000000200218. Epub 2023 Dec 8.
A clinical practice guideline (CPG) was created to standardize evaluation and treatment for patients with suspected anti-methyl-d-aspartate receptor (NMDAR) autoimmune encephalitis (AE), the most common AE in children. The objective of this study was to evaluate the CPG effect on time to diagnosis, treatment, and hospital length of stay (LOS).
Patients with an inpatient consult to pediatric rheumatology for AE during a 4-year period (period 2) after CPG implementation were identified. Data were extracted and compared with data over the preceding 4-year period (period 1).
During period 1, fewer patients underwent diagnostic testing than during period 2 (34 vs 80). Number of patients diagnosed with AE did not differ from period 1 to that from period 2 (NMDAR AE 9 vs 8; seronegative AE 4 vs 5). The average time to diagnostic evaluation with lumbar puncture decreased from 5.4 to 1.5 days ( = 0.0082), and time to treatment decreased from 7.6 to 3.9 days ( = 0.018). LOS showed a trend toward improvement (40.4-29.2 days ( = 0.23)).
Creation of a CPG for patients with suspected AE was associated with an improved time to diagnostic evaluation and treatment. With the CPG, more patients underwent AE testing, though total diagnoses remained the same.
制定了一项临床实践指南（CPG），以规范疑似抗甲基 - D - 天冬氨酸受体（NMDAR）自身免疫性脑炎（AE）患者的评估和治疗，这是儿童中最常见的AE类型。本研究的目的是评估CPG对诊断时间、治疗时间和住院时长（LOS）的影响。
确定在CPG实施后的4年期间（第2阶段）因AE向儿科风湿病科进行住院咨询的患者。提取数据并与前4年期间（第1阶段）的数据进行比较。
在第1阶段，接受诊断测试的患者少于第2阶段（34例对80例）。从第1阶段到第2阶段，诊断为AE的患者数量没有差异（NMDAR AE 9例对8例；血清阴性AE 4例对5例）。腰椎穿刺进行诊断评估的平均时间从5.4天降至1.5天（P = 0.0082），治疗时间从7.6天降至3.9天（P = 0.018）。住院时长有改善趋势（40.4天至29.2天（P = 0.23））。
为疑似AE患者制定CPG与诊断评估和治疗时间的改善相关。通过CPG，更多患者接受了AE检测，尽管总诊断数保持不变。
