预测紧急部门的骚动
Bijan Ketabchi1, Lynn Babcock2, Yin Zhang3
1Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
儿童和青少年的侵略性简要评分 (BRACHA) 和其缩短版本 (BRACHA-S) 准确地预测了年轻人向急诊室 (ED) 提出的需要干预的动荡. 这些工具可以实现早期风险分层,以提高患者的安全性.
科学领域:
- 儿科急救医学 儿科急救医学
- 儿童和青少年精神病学 儿童和青少年精神病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 紧急部门 (ED) 经常遇到年轻人的心理和行为健康 (MBH) 问题.
- 需要干预的激动对患者和工作人员构成风险,并使ED工作流程复杂化.
- 早期识别易受煽动风险的年轻人对于及时干预和资源分配至关重要.
研究的目的:
- 评估儿童和青少年侵略性简要评分 (BRACHA) 及其组成部分,以预测ED年轻人需要干预的动荡.
- 开发和验证一种工具,用于在ED环境中对激动的年轻人进行早期风险分层.
- 为制定有针对性的干预措施和资源管理策略提供信息.
主要方法:
- 一项回顾性队列研究,对32,906例ED MBH遭遇,涉及5-18岁患者 (2012-2020年).
- 纳入标准需要完成BRACHA评估.
- 需要干预的激发是主要结果,预测准确度以接收器操作者特征曲线 (AUROC) 下的面积来衡量.
- 使用回归分析开发了一个缩短版本BRACHA-S,并创建了风险分层层.
主要成果:
- 10.7%的ED MBH遭遇导致动荡需要干预.
- 布拉卡显示出强大的预测准确性,AUROC为0.81 (95%CI为0.79-0.82).
- 在BRACHA-S取得的AUROC为0.80 (95%CI为0.78-0.81).
- 与低风险相比,需要干预的煽动风险比率为中等风险的6.0%,高风险的BRACHA-S级别为14.0.
结论:
- 在儿科ED环境中,BRACHA和BRACHA-S都是预测需要干预的动荡的有效工具.
- 这些经过验证的工具支持准确的风险分层,使积极的管理策略成为可能.
- 实施BRACHA和BRACHA-S可以提高患者的安全性,并优化对患有MBH问题的年轻人紧急护理的资源配置.
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