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A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
[Profile of the child seen in the resuscitation room]
Iris Alonso Sánchez1, Cristina Parra Cotanda1, María Melé Casas1
1Hospital Sant Joan de Déu. Esplugues de Llobregat. Barcelona. España.
Insights
Seriously ill children in the pediatric resuscitation room (RR) are often school-aged and arrive by ambulance for trauma. Medical conditions, unlike trauma, are a significant risk factor for poor outcomes in these pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care
- Trauma Care
Background:
- Seriously ill children present a significant challenge for healthcare professionals.
- Understanding patient profiles optimizes resource allocation and professional training.
Purpose of the Study:
- To characterize patients admitted to the resuscitation room (RR) of a pediatric emergency department (PED).
- To identify risk factors associated with poor outcomes in this patient population.
Main Methods:
- An observational analytical study was conducted in a pediatric hospital's PED over one year.
- Data collected included demographics, arrival details, reasons for care, procedures, diagnoses, and disposition.
- Logistic regression analysis identified independent risk factors for poor evolution.
Main Results:
- 114 patients were included; median age was 9.9 years, with 65.8% males.
- Most patients arrived from home or the street, primarily by ambulance, with polytrauma as the leading diagnosis.
- Internal medical conditions and age under 2 years were identified as risk factors for poor outcomes, with medical cause being an independent predictor.
Conclusions:
- The typical patient in the pediatric RR is a school-aged child with stable polytrauma arriving by ambulance.
- Children presenting with internal medical conditions face poorer outcomes compared to trauma patients.
Objective:
The attention provided to the seriously ill represents a great challenge for health care professionals; familiarity with this profile will allow for the optimal use of resources and will also lead to an improvement in the training of the health professionals. We sought to understand the characteristics of patients seen in the resuscitation room (RR) of a pediatric emergency department (PED), and to determine the risk factors for a poor evolution.
Methods:
An observational analytical study was carried out in the PED of a third-level pediatric hospital from September 2016 through August 2017. Included were those patients attended to in the RR; we analyzed their demographic variables, where they were from, how they arrived at the hospital, their reasons for seeking care (medical vs accident), procedures applied, treatments given, diagnoses, and discharge destination. We used logistic regression analysis to determine the independent risk factors for poor evolution.
Results:
Included were 114 patients. Their median age was 9.9 years (p25-75=4.0-14.7); 65.8% were male. The patients arrived from the street (51.8%) and from home (31.6%); more than two thirds arrived by ambulance (69.3%). Some 42.1% presented with an unstable pediatric assessment triangle (PAT). Some 64.9% were seen for polytrauma (87.8% with stable PAT). Procedures were carried out on 79.8% of the patients. The most frequent diagnoses were polytrauma (64.9%) and convulsive status (14%). The discharge destinations were: home (28.1%), hospital ward (35.1%), intensive care unit (30.7%), and surgery (4.4%); two patients died in the RR. With the univariate study, we identified risk factors for poor outcome: internal medical condition (52.5% vs 21.6%, p=0.001) and age <2 years (55.6% vs 28.1%, p=0.023). In the multivariate study, the medical cause was maintained as an independent risk factor (OR 4 (CI 95% 1.7-9.2), p=0.001).
Conclusions:
The profile of the patient seen in the RR is of a school-age child in stable condition, arriving by ambulance for polytrauma. The children seen for internal medical reasons had poorer outcomes.
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