从全州的样本中对短暂解决的不明原因事件 (BRUE) 的住院和评估
Lindsay H Boles1, Kathleen A Noorbakhsh2, Tracie Smith3
1Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States of America.
The American journal of emergency medicine
|October 6, 2023
概括
2016年临床实践指南对短暂解决的不明原因事件 (BRUE) 减少了学术儿科医院的住院治疗. 然而,非儿科医院的结果不尽相同,这表明需要在这些环境中更好地执行指南.
科学领域:
- 儿科急救医学 儿科急救医学
- 临床实践指南 临床实践指南
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 2016年临床实践指南 (CPG) 将明显的危及生命的事件 (ALTE) 替换为短暂解决的不明原因事件 (BRUE).
- 这种CPG减少了儿童医院的住院和测试.
- CPG对非儿科医院的影响尚不清楚.
研究的目的:
- 评估2016年CPG出版后,非儿科医院的BRUE诊断和管理的变化.
- 评估CPG对这些环境中BRUE住院和临床检测率的影响.
主要方法:
- 在178个伊利诺伊州的非儿科急诊室 (ED) 中,从2013年到2019年,对婴儿 (<1岁) 与BRUE/ALTE代码的接触进行了回顾性研究.
- 诊断数和入院/转移率的中断时间序列分析;临床测试的千平方测试.
- 结果分层成学术和社区EDs.
主要成果:
- 学术EDs显示,CPG后的BRUE诊断和入院数量显著下降.
- 社区EDs在CPG后的BRUE诊断或入院趋势中没有显著变化.
- 社区ED患者在一些测试 (如胸部放射) 中表现较低,但在其他测试 (如 pertussis测试) 中表现较高.
结论:
- 2016年CPG有效地减少了学术ED的BRUE诊断和入院,但对社区ED的影响有限.
- 对BRUE CPG的实施工作需要在非儿科环境中加强,特别是社区ED.
- 为优化儿科BRUE患者的护理,需要在各种医疗环境中加强对指南的遵守.
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