Technology-dependency among patients discharged from a children's hospital: a retrospective cohort study.
Technology-dependency among patients discharged from a children's hospital: a retrospective cohort study.
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DOI：
10.1186/1471-2431-5-8
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发表时间：
2005-05-09
期刊：
影响因子：
2.4
通讯作者：
Neff JM
中科院分区：
文献类型：
--
作者：
Feudtner C;Villareale NL;Morray B;Sharp V;Hays RM;Neff JM
医疗技术的进步可能会增加技术依赖（TD）的儿童人口。我们评估了从儿童医院出院的被判定为TD的儿童的比例，并确定了出院时最常见的设备和处方药的数量。图表审查100名随机选择的病人从所有服务出院的儿童医院在2000年。由4名研究者独立审查数据，如果该技术的失败或退出可能会产生足以需要住院治疗的不良健康后果，则将病例归类为TD。只有3或4名评定者同意的病例才被归类为TD。在100名随机抽样的患者中，中位年龄为7岁（范围：1天至24岁），52%为男性，86%主要讲英语，54%为私人保险。中位住院时间为3天（范围：1 - 103天）。未确诊者占5%以上。41%被认为是技术依赖，20%依赖于设备，32%依赖于药物，11%依赖于设备和药物。出院时的器械包括胃造口术和空肠造口术管（10%）、中心静脉导管（7%）和气管切开术（1%）。处方药的中位数为2（范围：0-13），12%的病例有5种或更多种药物。计划为7%的病例提供家庭护理服务。从儿童医院出院的儿童对技术的依赖很普遍。
Advances in medical technology may be increasing the population of children who are technology-dependent (TD). We assessed the proportion of children discharged from a children's hospital who are judged to be TD, and determined the most common devices and number of prescription medications at the time of discharge. Chart review of 100 randomly selected patients from all services discharged from a children's hospital during the year 2000. Data were reviewed independently by 4 investigators who classified the cases as TD if the failure or withdrawal of the technology would likely have adverse health consequences sufficient to require hospitalization. Only those cases where 3 or 4 raters agreed were classified as TD. Among the 100 randomly sampled patients, the median age was 7 years (range: 1 day to 24 years old), 52% were male, 86% primarily spoke English, and 54% were privately insured. The median length of stay was 3 days (range: 1 to 103 days). No diagnosis accounted for more than 5% of cases. 41% were deemed to be technology dependent, with 20% dependent upon devices, 32% dependent upon medications, and 11% dependent upon both devices and medications. Devices at the time of discharge included gastrostomy and jejeunostomy tubes (10%), central venous catheters (7%), and tracheotomies (1%). The median number of prescription medications was 2 (range: 0–13), with 12% of cases having 5 or more medications. Home care services were planned for 7% of cases. Technology-dependency is common among children discharged from a children's hospital.