Febrile seizure: measuring adherence to AAP guidelines among community ED physicians.
Febrile seizure: measuring adherence to AAP guidelines among community ED physicians.
复制标题
热性惊厥：衡量社区急诊医生对 AAP 指南的遵守情况。
DOI：
10.1097/01.pec.0000226870.49427.a5
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发表时间：
2006
影响因子：
1.4
通讯作者：
Rudolph,JamesR
中科院分区：
文献类型：
--
作者：
Hampers,LouisC;Thompson,DavidA;Bajaj,Lalit;Tseng,BrianS;Rudolph,JamesR
目的：1996年，美国儿科学会公布了热性惊厥急性处理的实践参数。这些指南强调了典型的良性性质的条件，并阻止积极的神经诊断评价。这些建议在多大程度上被普通急诊医生采纳尚不清楚。我们试图描述最近的模式，急诊科（艾德）评价热性惊厥与这些parameters.Methods：6个月和6岁之间的儿童诊断为”热性惊厥”（国际疾病分类，第九次修订，临床修改780.31）在全国42个社区医院普通急诊室的记录进行了回顾性分析。从2002年10月至2003年9月的艾德医生计费服务的电子记录被用来识别相关记录。数据已输入专有模板文件系统，所有图表均由对相关结果不知情的专业编码员进行审查。资源利用率（包括腰椎穿刺，X线摄影，住院）noted.Results：共1029图表符合纳入标准。腰椎穿刺的总体发生率为5.2%，变化与年龄密切相关（8.4%< 18 months old vs 3.3%><18个月）。这种低比率和年龄歧视与美国儿科学会的指导方针一致。虽然不推荐在热性惊厥的常规评估中，但计算机断层扫描是11%的评估的一部分。总的入院率或转院率为12%。结论：临床参数公布后6年，腰椎穿刺在热性惊厥评估中的应用并不常见，大多数患者出院回家。然而，相对频繁地使用头部计算机断层扫描与这些实践指南不一致，值得进一步调查。
Objective:In 1996, the American Academy of Pediatrics published practice parameters for the acute management of febrile seizure. These guidelines emphasize the typically benign nature of the condition and discourage aggressive neurodiagnostic evaluation. The extent to which these suggestions have been adopted by general emergency medicine practitioners is unknown. We sought to describe recent patterns of the emergency department (ED) evaluation of febrile seizures with respect to these parameters.Methods:A retrospective review of records of children between 6 month and 6 years of age diagnosed with" febrile seizure"(International Classification of Diseases, Ninth Revision, Clinical Modification 780.31) at 42 community hospital general EDs nationwide was performed. Electronic records of an ED physician billing service from October 2002 to September 2003 were used to identify relevant records. Data had been entered into a proprietary template documentation system, and all charts were reviewed by a professional coder blinded to outcomes of interest. Rates of resource utilization (including lumbar puncture, radiography, hospital admission) were noted.Results:A total of 1029 charts met inclusion criteria. The overall rate of lumbar puncture was 5.2%, and variations were strongly associated with age (8.4%< 18 months old vs 3.3%> 18 months old). This low rate and age discrimination were consistent with the guidelines of the American Academy of Pediatrics. Although not recommended in the routine evaluation of febrile seizure, computed tomography was part of the evaluation in 11%. The overall rate of admissions or transfers was 12%.Conclusions:Six years after publication of practice parameters, the use of lumbar puncture in the evaluation of febrile seizure is uncommon and most patients are discharged home. However, the relatively frequent use of head computed tomography is inconsistent with these practice guidelines and merits further investigation.