Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Acad Emerg Med. 2024 Jun;31(6):555-563. doi: 10.1111/acem.14875. Epub 2024 Mar 18.
A better characterization of deaths in children following emergency care is needed to inform timely interventions. This study aimed to describe the timing, location, and causes of death to 1 year among a cohort of injured and medically ill children.
We conducted a retrospective cohort study of children <18 years requiring emergency care in six states from January 1, 2012, through December 31, 2017, with follow-up through December 31, 2018, for patients who were not discharged from the emergency department (ED). In this cohort, 1-year mortality, time to death within 1 year, and causes of death were assessed from ED, inpatient, and vital status records.
There were 546,044 children during the 6-year period. The 1-year mortality rate was 2.2% (n = 1356) for injured children and 1.4% (n = 6687) for medically ill children. Matched death certificates were available for 861 (63.5%) of 1356 deaths in the injury cohort and for 4712 (70.5%) of 6687 deaths in the medical cohort. Among deaths in the injury cohort, 1274 (94.0%) occurred in the ED or hospital. The most common causes of death were motor vehicle collisions, firearm injuries, and pedestrian injuries. Among the 6687 deaths in the medical cohort, 5081 (76.0%) children died in the ED or hospital (primarily in the ED) and 1606 (24.0%) occurred after hospital discharge. The most common causes of death were sudden infant death syndrome, suffocation and drowning, and congenital conditions.
The 1-year mortality of children presenting to an ED is 2.2% for injured children and 1.4% for medically ill children with most deaths occurring in the ED. Future interventional trials, quality improvement efforts, and health policy focused in the ED could have the potential to improve outcomes of pediatric patients.
为了及时采取干预措施，需要更好地描述接受紧急治疗的儿童死亡的时间、地点和原因。本研究旨在描述受伤和患有疾病的儿童队列中，在 1 年内死亡的时间、地点和原因。
我们对 2012 年 1 月 1 日至 2017 年 12 月 31 日期间在六个州因伤和因病需要紧急护理的<18 岁儿童进行了回顾性队列研究，对于未从急诊部（ED）出院的患者，随访至 2018 年 12 月 31 日。在该队列中，从 ED、住院和生命状态记录中评估 1 年死亡率、1 年内死亡时间和死因。
在 6 年期间，共有 546,044 名儿童。受伤儿童的 1 年死亡率为 2.2%（n=1356），患有疾病儿童的 1 年死亡率为 1.4%（n=6687）。在受伤队列的 1356 例死亡中，有 861 例（63.5%）可获得匹配的死亡证明，在医学队列的 6687 例死亡中，有 4712 例（70.5%）可获得匹配的死亡证明。在受伤队列的死亡中，有 1274 例（94.0%）发生在 ED 或医院。最常见的死因是机动车碰撞、火器伤和行人伤。在医学队列的 6687 例死亡中，有 5081 例（76.0%）儿童在 ED 或医院（主要在 ED）死亡，有 1606 例（24.0%）在出院后死亡。最常见的死因是婴儿猝死综合征、窒息和溺水以及先天性疾病。
因伤就诊于 ED 的儿童 1 年死亡率为 2.2%，因疾病就诊的儿童为 1.4%，大多数死亡发生在 ED。未来以 ED 为重点的干预试验、质量改进措施和卫生政策有可能改善儿科患者的结局。
