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在患有复杂尾炎的儿童中错过了初步诊断的机会
Shruthi Srinivas, Wendy Jo Svetanoff1, Sidhant Kalsotra2
1Department of Pediatric Surgery, Nationwide Children's Hospital.
Pediatric emergency care
|December 27, 2024
概括
儿童复杂尾炎的延迟诊断,称为初始诊断机会错失 (MOID),经常发生在医院之外. 这导致更糟糕的结果,特别是在年轻的,非英语儿童.
科学领域:
- 儿科手术 儿科手术
- 紧急医疗 紧急医疗
- 诊断的准确性 诊断的准确性
背景情况:
- 儿童急性尾炎的延迟诊断可能导致复杂的尾炎和穿孔.
- 错过初始诊断机会 (MOID) 是延迟诊断的一个关键因素,通常发生在专门的儿科中心之外.
研究的目的:
- 在所有初始呈现设施中确定患有复杂尾炎的儿童的MOID率.
- 在儿科复杂尾炎中识别与MOID相关的风险因素.
主要方法:
- 复杂尾炎的儿童 (≤18岁) 进行尾切除 (2018-2022年) 的回顾性评估.
- MOID定义为在手术前7天内对相关症状进行评估,而没有对尾炎进行诊断.
- 用于分析风险因素的物流回归和UpSet图.
主要成果:
- 856名儿童中有16.4%患有MOID,主要来自非三级机构 (急诊,当地ED,初级保健).
- MOID与年龄较小和非英语/西班牙语的主要语言相关;没有保险的患者的MOID较低.
- MOID与增加的并发症,更长的住院时间和更高的再入院率相关.
结论:
- 在儿童复杂尾炎的非三级环境中,MOID很普遍.
- 年龄较小的儿童和不说英语的人患MOID的风险更高.
- 需要改进的诊断策略,包括口译服务和算法评估,在非三级设施.
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