Rivera-Koberstein Ninoshka, Agrawal Amit, Galwankar Sagar
Department of Emergency Medicine, Sarasota Memorial Hospital, Florida State University, Sarasota, FL, USA.
Department of Neurosurgery, AIIMS, Delhi, India.
J Emerg Trauma Shock. 2025 Jan-Mar;18(1):26-31. doi: 10.4103/jets.jets_88_24. Epub 2025 Feb 27.
Medical literature on emergency care for children with special healthcare needs (SHCNs) reports the inherent challenges in the managing of these children, like limited history, distress for patients and families, and unique management requirements for healthcare teams. This study analyzed the demographic data on children with SHCNs to explore de-escalation strategies, the effectiveness of chemical de-escalation, and clinical management strategies used and compared the length of stay in the emergency department (ED) between patients who received medications and those who did not.
This was a retrospective and cross-sectional study. Data were collected from the last 150 patients diagnosed with SHCNs across three ED s within this hospital system since July 1, 2023. Children aged 18 years or younger diagnosed with SHCNs requiring special modifications. Chi-square test, Mann-Whitney -test, and Kruskal-Wallis -test.
The demographic analysis showed that 60% of children with SHCNs were female, with a mean age of 12.3 years. The most common presentation time was 6-8 pm. autism spectrum disorder (28%) and anxiety disorder (27%) were the most frequent diagnoses, with substance abuse present in 45% of patients. Medications helped reduce the ED stay, which was statistically significant, suggesting that medications may facilitate effective de-escalation; At the same time, in a few cases, verbal de-escalation also appeared helpful. There is a need for robust documentation on verbal de-escalation strategies, such as details on patients who did not receive medications and were successfully managed verbally or required repeated reassurance.
This study provides insight into the diverse challenges of managing children with SHCNs in the emergency settings. The high prevalence of substance abuse, particularly in children with autism spectrum, increases the complexity of care. While medications may reduce ED stay, further research is needed to understand this patient population's complex needs better.
关于有特殊医疗需求（SHCNs）儿童的急诊护理医学文献报道了管理这些儿童时存在的固有挑战，如病史有限、患者及其家庭的痛苦，以及医疗团队独特的管理要求。本研究分析了SHCNs儿童的人口统计学数据，以探索降级策略、化学降级的有效性以及所采用的临床管理策略，并比较了接受药物治疗和未接受药物治疗的患者在急诊科（ED）的住院时间。
这是一项回顾性横断面研究。自2023年7月1日起，从该医院系统内三个急诊科最近诊断为SHCNs的150例患者中收集数据。年龄在18岁及以下、诊断为SHCNs且需要特殊调整的儿童。采用卡方检验、曼-惠特尼检验和克鲁斯卡尔-沃利斯检验。
人口统计学分析显示，60%的SHCNs儿童为女性，平均年龄为12.3岁。最常见的就诊时间是下午6点至8点。自闭症谱系障碍（28%）和焦虑症（27%）是最常见的诊断，45%的患者存在药物滥用问题。药物有助于缩短急诊科住院时间，这在统计学上具有显著意义，表明药物可能有助于有效降级；同时，在少数情况下，言语降级似乎也有帮助。需要有关于言语降级策略的详细记录，例如未接受药物治疗但通过言语成功管理或需要反复安抚的患者的详细情况。
本研究深入了解了在急诊环境中管理SHCNs儿童所面临的各种挑战。药物滥用的高发生率，尤其是在自闭症谱系儿童中，增加了护理的复杂性。虽然药物可能会缩短急诊科住院时间，但需要进一步研究以更好地了解这一患者群体的复杂需求。
