建立以结果为导向的生命体征范围,用于医院前环境中的儿童
Sriram Ramgopal1, Christopher M Horvat2, Michelle L Macy1
1Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
概括
新的数据驱动的生命体征值可以更好地识别在紧急医疗服务 (EMS) 中需要救生干预的儿童. 这些精细的儿科生命体征范围改善了重症儿童的医院前评估和资源分配.
科学领域:
- 儿科急救医学 儿科急救医学
- 在医院前的护理.
- 在医疗保健中的数据科学.
背景情况:
- 儿科生命体征对于医院前评估至关重要,但目前的标准往往会将太多的儿童标记为异常.
- 这种过度识别导致生命救助干预 (LSI) 率较低,尽管在医院前环境中存在异常的生命体征.
- 需要更精确,数据驱动的生命体征值来指导临床决策.
研究的目的:
- 建立与医院前救生干预 (LSI) 相关的儿科生命体征的数据驱动值.
- 提高在医院前环境中识别需要关键干预的儿童的准确性.
- 优化紧急医疗服务 (EMS) 协议和资源分配的利用.
主要方法:
- 分析2022年儿童 (<18岁) 紧急医疗服务 (EMS) 患者遭遇的全国数据库.
- 评估心率 (HR),呼吸率 (RR) 和静脉血压 (SBP) 的Z-分数及其与LSI的关联.
- 切割点分析的应用,以确定生命体征的最佳范围,平衡LSI预测的灵敏度和特异性.
主要成果:
- 分析了超过98.7万例儿科病例,其中4.3%的病例发生了LSI.
- 心率,呼吸率和缩血压显示了与LSI的U形关联.
- 更高的特异性标准产生了从84.1%到93.7%的特异性,其中RR表现最好;更高的灵敏性标准实现了从62.3%到84.4%的灵敏度.
结论:
- 从数据分析中得出的年龄调整的生命体征范围与LSI的需要有关.
- 这些精细的范围可以区分儿童在更高或更低的危险关键干预措施.
- 实施这些范围可以提高医院前评估,优化协议使用,并指导儿科患者的运输决策.
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