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Mortality after paediatric emergency calls for patients with or without pre-existing comorbidity: a nationwide
Vibe Maria Laden Nielsen1,2, Morten Breinholt Søvsø3, Regitze Gyldenholm Skals4
1Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Selma Lagerløfs Vej 249, Gistrup, 9260, Denmark. vibe.n@rn.dk.
Insights
Many children requiring emergency medical services die from conditions other than trauma or cardiac arrest. Medical symptoms, not just trauma or pediatric out-of-hospital cardiac arrest (POHCA), are significant factors in pediatric mortality, especially for those with comorbidities.
Area of Science:
- Emergency medicine
- Pediatric critical care
- Public health
Background:
- Life-threatening conditions are rare in children.
- Paediatric prehospital research predominantly focuses on trauma and paediatric out-of-hospital cardiac arrests (POHCA).
- Understanding the spectrum of conditions leading to paediatric emergency calls and their association with mortality is crucial.
Purpose of the Study:
- To determine the distribution of trauma, POHCA, and other medical symptoms among paediatric emergency call survivors and non-survivors.
- To analyze the relationship between these clinical presentations and mortality in children, considering pre-existing comorbidities.
Main Methods:
- A nationwide population-based cohort study was conducted in Denmark from 2016-2021.
- Data included all emergency calls for children aged ≤15 years, excluding interhospital transfers.
- Cox regression models were used to assess the association between clinical presentations and 7-day mortality, stratified by comorbidity status.
Main Results:
- The study analyzed 76,956 unique patients, with an annual all-cause mortality rate of 7 per 100,000 children.
- Among non-survivors without comorbidity, POHCA accounted for 46.3% of emergency calls, compared to 27.6% for those with comorbidity.
- Medical symptoms, excluding POHCA, were the reason for 28.9% of calls in non-survivors without comorbidity and 55.2% in those with comorbidity.
Conclusions:
- A significant proportion of paediatric emergency calls, particularly in non-survivors with comorbidities, were due to medical symptoms rather than trauma or POHCA.
- These findings highlight the importance of addressing a broader range of medical conditions in paediatric emergency preparedness and training.
- The study provides valuable data for directing paediatric in-service training within emergency medical services.
Background:
Life-threatening conditions are infrequent in children. Current literature in paediatric prehospital research is centred around trauma and paediatric out-of-hospital cardiac arrests (POHCA). The aims of this study were to (1) outline the distribution of trauma, POHCA or other medical symptoms among survivors and non-survivors after paediatric emergency calls, and (2) to investigate these clinical presentations' association with mortality in children with and without pre-existing comorbidity, respectively.
Methods:
Nationwide population-based cohort study including ground and helicopter emergency medical services in Denmark for six consecutive years (2016-2021). The study included all calls to the emergency number 1-1-2 regarding children ≤ 15 years (N = 121,230). Interhospital transfers were excluded, and 1,143 patients were lost to follow-up. Cox regressions were performed with trauma or medical symptoms as exposure and 7-day mortality as the outcome, stratified by 'Comorbidity', 'Severe chronic comorbidity' and 'None' based on previous healthcare visits.
Results:
Mortality analysis included 76,956 unique patients (median age 5 (1-12) years). Annual all-cause mortality rate was 7 per 100,000 children ≤ 15 years. For non-survivors without any pre-existing comorbidity (n = 121), reasons for emergency calls were trauma 18.2%, POHCA 46.3% or other medical symptoms 28.9%, whereas the distribution among the 134 non-survivors with any comorbidity was 7.5%, 27.6% and 55.2%, respectively. Compared to trauma patients, age- and sex-adjusted hazard ratio for patients with calls regarding medical symptoms besides POHCA was 0.8 [0.4;1.3] for patients without comorbidity, 1.1 [0.5;2.2] for patients with comorbidity and 6.1 [0.8;44.7] for patients with severe chronic comorbidity.
Conclusion:
In both non-survivors with and without comorbidity, a considerable proportion of emergency calls had been made because of various medical symptoms, not because of trauma or POHCA. This outline of diagnoses and mortality following paediatric emergency calls can be used for directing paediatric in-service training in emergency medical services.
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