Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Selma Lagerløfs Vej 249, Gistrup, 9260, Denmark.
Emergency Medical Services, North Denmark Region, Hjulmagervej 20, Aalborg, 9000, Denmark.
Scand J Trauma Resusc Emerg Med. 2024 May 28;32(1):48. doi: 10.1186/s13049-024-01212-2.
Life-threatening conditions are infrequent in children. Current literature in paediatric prehospital research is centred around trauma and paediatric out-of-hospital cardiac arrests (POHCA). The aims of this study were to (1) outline the distribution of trauma, POHCA or other medical symptoms among survivors and non-survivors after paediatric emergency calls, and (2) to investigate these clinical presentations' association with mortality in children with and without pre-existing comorbidity, respectively.
Nationwide population-based cohort study including ground and helicopter emergency medical services in Denmark for six consecutive years (2016-2021). The study included all calls to the emergency number 1-1-2 regarding children ≤ 15 years (N = 121,230). Interhospital transfers were excluded, and 1,143 patients were lost to follow-up. Cox regressions were performed with trauma or medical symptoms as exposure and 7-day mortality as the outcome, stratified by 'Comorbidity', 'Severe chronic comorbidity' and 'None' based on previous healthcare visits.
Mortality analysis included 76,956 unique patients (median age 5 (1-12) years). Annual all-cause mortality rate was 7 per 100,000 children ≤ 15 years. For non-survivors without any pre-existing comorbidity (n = 121), reasons for emergency calls were trauma 18.2%, POHCA 46.3% or other medical symptoms 28.9%, whereas the distribution among the 134 non-survivors with any comorbidity was 7.5%, 27.6% and 55.2%, respectively. Compared to trauma patients, age- and sex-adjusted hazard ratio for patients with calls regarding medical symptoms besides POHCA was 0.8 [0.4;1.3] for patients without comorbidity, 1.1 [0.5;2.2] for patients with comorbidity and 6.1 [0.8;44.7] for patients with severe chronic comorbidity.
In both non-survivors with and without comorbidity, a considerable proportion of emergency calls had been made because of various medical symptoms, not because of trauma or POHCA. This outline of diagnoses and mortality following paediatric emergency calls can be used for directing paediatric in-service training in emergency medical services.
危及生命的情况在儿童中较为少见。目前，儿科院前研究的文献主要集中在创伤和儿科院外心脏骤停（POHCA）上。本研究的目的是：（1）描述儿童急救电话后幸存者和非幸存者中创伤、POHCA 或其他医疗症状的分布情况；（2）分别调查这些临床表现与无合并症和有合并症儿童死亡率之间的关系。
这是一项在丹麦进行的全国范围内基于人群的队列研究，纳入了六年（2016-2021 年）期间的地面和直升机紧急医疗服务。研究纳入了所有拨打 1-1-2 急救电话的儿童（≤15 岁）（N=121230）。排除了院内转院患者，有 1143 名患者失访。采用 Cox 回归分析，以创伤或医疗症状为暴露因素，以 7 天死亡率为结局，根据之前的医疗就诊情况进行分层，分为“合并症”、“严重慢性合并症”和“无”。
76956 名独特的患者（中位年龄 5（1-12）岁）纳入死亡率分析。每年所有原因的死亡率为每 10 万名儿童中 7 人。对于无任何合并症的非幸存者（n=121），急救电话的原因是创伤 18.2%、POHCA 46.3%或其他医疗症状 28.9%，而有任何合并症的 134 名非幸存者中分别为 7.5%、27.6%和 55.2%。与创伤患者相比，无合并症的患者，除 POHCA 外，因其他医疗症状拨打急救电话的患者，年龄和性别校正后的危险比为 0.8 [0.4；1.3]，有合并症的患者为 1.1 [0.5；2.2]，有严重慢性合并症的患者为 6.1 [0.8；44.7]。
在无合并症和有合并症的非幸存者中，相当一部分急救电话是由于各种医疗症状而不是创伤或 POHCA 引起的。本研究概述了儿童急救后的诊断和死亡率，可用于指导急救医疗服务的儿科在职培训。
