Transport of critically ill children in a resource-limited setting
Transport of critically ill children in a resource-limited setting
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DOI：
10.1007/s00134-003-1888-7
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发表时间：
2003-09-01
影响因子：
38.9
通讯作者：
Argent, A
中科院分区：
文献类型：
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作者：
Hatherill, M;Waggie, Z;Argent, A
Objective.在资源有限的情况下，对儿科重症监护病房（PICU）的转运活动和转运相关不良事件进行审计。设计和设置。南非开普敦一所大学儿童医院的22张区域PICU病床。对直接从其他医院转来的所有儿童进行为期1年的前瞻性审计。收集了患者人口统计学、诊断类别、转诊医院、转运人员、运输方式以及技术、临床和关键不良事件的数据。数据为中位数（四分位距）或百分比。对202例患儿的转移情况进行了分析，平均年龄为2.8个月（1.1-14），平均体重为3.5 kg（2.5-8.1）。大多数转移是由辅助医务人员（82%）和通过公路救护车（76%）进行的。36%的儿童发生了一个或多个技术不良事件，27%的儿童发生了临床不良事件，9%的儿童发生了严重不良事件。由重症监护人员（10%）进行的检索，均来自农村医院，技术不良事件的发生率较低（0%）。从大都市地区内的非学术医院转移的儿童的技术（44%），临床（39%）和关键（17%）不良事件的发生率最高。粗死亡率为17%（n=34）。技术不良事件与死亡率无关。在转移过程中，死亡者发生休克（32%）或缺氧（26%）的可能性高于存活者（分别为10%和11%）。与转移相关的不良事件发生率很高，最常见于从非学术性大都市医院转移的患者。需要进一步的研究来评估区域儿科生命支持培训或专业检索团队对临床不良事件和死亡率的影响。
Objective. To audit paediatric intensive care unit (PICU) transfer activity and transfer-related adverse events in a resource-limited setting.Design and setting. Twenty-two bed regional PICU of a university children's hospital in Cape Town, South Africa. Prospective 1-year audit of all children transferred directly from other hospitals. Data were collected for patient demographics, diagnostic category, referring hospital, transferring personnel, mode of transport, and technical, clinical, and critical adverse events. Data are median (interquartile range) or percentages. The transfers of 202 children, median age 2.8 months (1.1-14), median weight 3.5 kg (2.5-8.1) were analysed.Results. Most transfers were performed by paramedic personnel (82%) and via road ambulance (76%). One or more technical adverse events occurred in 36%, clinical adverse events in 27%, and critical adverse events in 9% of children. Retrievals by intensive care staff (10%), all from rural hospitals, had a lower incidence of technical adverse events (0%). Children transferred from non-academic hospitals within the metropolitan area had the highest incidence of technical (44%), clinical (39%), and critical (17%) adverse events. Crude mortality was 17% (n=34). Technical adverse events were not associated with mortality. Non-survivors were more likely to develop shock (32%) or hypoxia (26%) during transfer than survivors (10% and 11%, respectively).Conclusions. There is a high incidence of transfer-related adverse events, most commonly in transfers from non-academic metropolitan hospitals. Further studies are needed to assess the impact of regional paediatric life support training or a specialised retrieval team on clinical adverse events and mortality.