Abdullah Naseef, Majiet Naqeeb, Sobuwa Simpiwe
Emergency Medical Services, Western Cape Government Health & Wellness, Cape Town, South Africa.
Department of Emergency Medical Care & Rescue, Faculty of Health Sciences, Durban University of Technology, KwaZulu-Natal, South Africa.
BMC Emerg Med. 2024 Dec 18;24(1):234. doi: 10.1186/s12873-024-01146-z.
Paediatric mortality rates in low- and middle-income countries account for over 80% of the global burden. In South Africa, one in every 33 children will not reach the age of five. Despite the high mortality rate, there is a paucity of data describing the prehospital paediatric under-five emergency care burden in South Africa. Such data are essential to inform the development of local prehospital emergency care guidelines and targeted prevention strategies.
This study describes the prehospital paediatric under-five emergency care burden managed by the Western Cape Government Health and Wellness (WCGHW) Emergency Medical Services (EMS) in South Africa.
A retrospective review of the prehospital records was conducted, extracting epidemiological and clinical data from the WCGHW EMS patient record database. The review included all paediatric cases under-five, managed between 1 January 2022 and 31 December 2023, in the Western Cape of South Africa.
In the 87 457 cases, there was a similar distribution between the primary cases (50.7%) and interfacility transfers (49.3%). Most activations emanated from rural areas (47 980, 54.9%), with respiratory emergencies (30 934, 35.4%), non-cardiac pain (11 381, 13.0%) and trauma (10 831,12.4%) being the most common presenting complaints. Most cases were prioritised as priority 2 (46 034, 52.6%), with most of these being older children between one and five years old (29 008, 63.0). Low acuity cases accounted for 67.2% (58 818) of the sample, with the highest mortality occurring between 29 days and 12 months (190, 52.9.%). Most patients spent less than one hour in the prehospital setting (64 431, 73.7%), with advanced airway management (748, 43.1%) being the most common airway intervention.
This first description of the prehospital paediatric under-five emergency care burden managed by the WCGHW EMS reveals a unique burden, particularly regarding the high interfacility transfer rates. As illustrated in graphical abstract, these findings underscore critical considerations for healthcare planners and the prehospital training environment. Future research among this population should focus on characterising the reasons for the high interfacility transfer rates through assessments of healthcare access, EMS care quality and post-EMS follow-up.
低收入和中等收入国家的儿童死亡率占全球负担的80%以上。在南非，每33名儿童中就有1名活不到五岁。尽管死亡率很高，但描述南非五岁以下儿童院外急救负担的数据却很少。这些数据对于制定当地的院外急救指南和有针对性的预防策略至关重要。
本研究描述了南非西开普省政府健康与福利部（WCGHW）紧急医疗服务（EMS）所管理的五岁以下儿童院外急救负担。
对院外记录进行回顾性研究，从WCGHW EMS患者记录数据库中提取流行病学和临床数据。该回顾涵盖了2022年1月1日至2023年12月31日期间在南非西开普省管理的所有五岁以下儿童病例。
在87457例病例中，主要病例（50.7%）和机构间转运病例（49.3%）的分布相似。大多数急救呼叫来自农村地区（47980例，54.9%），最常见的就诊主诉是呼吸急症（30934例，35.4%）、非心脏性疼痛（11381例，13.0%）和创伤（10831例，12.4%）。大多数病例被列为2级优先（46034例，52.6%），其中大多数是1至5岁的大龄儿童（29008例，63.0%）。低急症病例占样本的67.2%（58818例），死亡率最高发生在29天至12个月之间（190例，52.9%）。大多数患者在院外停留时间不到一小时（64431例，73.7%），高级气道管理（748例，43.1%）是最常见的气道干预措施。
WCGHW EMS对五岁以下儿童院外急救负担的首次描述揭示了一种独特的负担，特别是机构间转运率很高。如图形摘要所示，这些发现突出了医疗规划者和院外培训环境的关键考虑因素。对这一人群的未来研究应通过评估医疗可及性、EMS护理质量和EMS后随访来关注机构间转运率高的原因。
