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Priebe C, Bosse HM, Michael M, Picker O, Bernhard M, Tautz J. [Retrospective analysis of the resuscitation room management of nontraumatic critically ill children in a university emergency department (OBSERvE-DUS-PED study)]. DIE ANAESTHESIOLOGIE 2024; 73:656-667. [PMID: 39222093 PMCID: PMC11447138 DOI: 10.1007/s00101-024-01457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/09/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The establishment of a resuscitation room management for nontraumatic critically ill children appears to make sense. This study collected data of pediatric patients suffering from nontraumatic critically ill conditions treated in a resuscitation room. METHODS The retrospective OBSERvE-DUS-PED study (November 2019-October 2022) recorded pediatric patients (age < 18 years) who were admitted to the emergency department (ED) for resuscitation room care. The routinely documented data on treatment were taken from the hospital information system MEDICO® and the patient data management system COPRA® in accordance with the OBSERvE dataset. The study was approved by the Ethics Committee of the Medical Faculty of the Heinrich Heine University (2023-2377). RESULTS The study included 52 pediatric resuscitation room patients. Adolescents aged 14-17 years were the most frequent in the cohort representing 37% of the total and neonates/infants (0-1 year) were lowest at 8%. The most common symptoms categorized according to ABCDE problems were disturbance of consciousness (D) at 61%, cardiovascular failure (C) at 25%, respiratory insufficiency (B) at 6%, airway obstruction (A) and exposure/environment (E) problems each at 4%. The out-of-hospital and in-hospital emergency procedures were performed with the following frequencies: venous (58% vs. 65%), intraosseous (14% vs. 2%) and central venous access (0% vs. 12%), invasive airway management (35% vs. 8%), cardiopulmonary resuscitation (21% vs. 10%), vasopressors (15% vs. 17%), and intra-arterial pressure measurement (0% vs. 17%). The mean duration of resuscitation room management was 70 ± 43 min. The 30-day mortality was 17%. CONCLUSION The OBSERvE-DUS-PED study demonstrates the major challenges in the care of critically ill nontraumatic pediatric patients, both in out-of-hospital and in-hospital management. The variety and complexity of the referral diagnoses as well as the immediate vital threat to the patients make it appear sensible to treat such patients primarily in a resuscitation room of the ED due to the available material, infrastructural and personnel resources.
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Affiliation(s)
- Claudia Priebe
- Klinik für Allgemeine Pädiatrie, Kinderkardiologie und Neonatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, Düsseldorf, 40225, Deutschland
| | - Hans Martin Bosse
- Klinik für Allgemeine Pädiatrie, Kinderkardiologie und Neonatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, Düsseldorf, 40225, Deutschland
| | - Mark Michael
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Olaf Picker
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Michael Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - Juliane Tautz
- Klinik für Allgemeine Pädiatrie, Kinderkardiologie und Neonatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, Düsseldorf, 40225, Deutschland
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Nielsen VML, Søvsø MB, Skals RG, Bender L, Corfield AR, Lossius HM, Mikkelsen S, Christensen EF. Mortality after paediatric emergency calls for patients with or without pre-existing comorbidity: a nationwide population based cohort study. Scand J Trauma Resusc Emerg Med 2024; 32:48. [PMID: 38807153 PMCID: PMC11134704 DOI: 10.1186/s13049-024-01212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/24/2024] [Indexed: 05/30/2024] Open
Abstract
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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Affiliation(s)
- Vibe Maria Laden Nielsen
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Selma Lagerløfs Vej 249, Gistrup, 9260, Denmark.
- Emergency Medical Services, North Denmark Region, Hjulmagervej 20, Aalborg, 9000, Denmark.
| | - Morten Breinholt Søvsø
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Selma Lagerløfs Vej 249, Gistrup, 9260, Denmark
| | - Regitze Gyldenholm Skals
- Unit of Clinical Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, Aalborg, 9000, Denmark
| | - Lars Bender
- Paediatric Department, Aalborg University Hospital, Reberbansgade 15, Aalborg, 9000, Denmark
| | | | - Hans Morten Lossius
- Norwegian Air Ambulance Foundation, Postboks 414 Sentrum Oslo 0103, Norway, United Kingdom
| | - Søren Mikkelsen
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, , J. B. Winsløws Vej 4, Odense C 5000, Denmark
| | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Selma Lagerløfs Vej 249, Gistrup, 9260, Denmark
- Emergency Medical Services, North Denmark Region, Hjulmagervej 20, Aalborg, 9000, Denmark
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Arzoumanian A, Agopian A, Hovhannisyan M, Chekijian S, Baghdassarian A. Emergency medical services in Armenia: national call trends and future directions. Int J Emerg Med 2024; 17:65. [PMID: 38755551 PMCID: PMC11097514 DOI: 10.1186/s12245-024-00644-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/04/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Emergency medical services (EMS) are paramount to boosting health indices in lower-middle income countries (LMICs); however, lack of uniform data collection and analysis hinders system improvement efforts. In the present study, we describe patterns of EMS utilization in the Republic of Armenia and provide key insight into the quality of digital data collection methods. RESULTS For calls logged in the capital city, Yerevan, the majority had at least one missing field. The predominant complaint was high blood pressure among adults (34.4%) and fever among pediatrics (65.9%). A majority of patients were female (57.6%), adults (90.2%), and not transported to a hospital (85.0%). In the rural provinces, the data was largely intact. The predominant complaints were unspecified acute condition (27.4%) and high blood pressure (26.2%) among adults, and fever (43.9%) and unspecified acute condition (22.1%) among pediatrics. A majority of patients were female (57.1%), adults (94.2%), and not transported to a hospital (78.9%). CONCLUSIONS Our study reveals that the majority of calls to the EMS system are for concerns not needing in-hospital treatment and for acute exacerbation of chronic conditions. Our study also provides a critical foundation for the improvement of EMS systems in Armenia and in other nations in transition. The Locator software has the potential to be a valuable tool to the MoH if it is improved for surveillance purposes, and future synchronization of digital systems would provide easy access to critical information on population health needs and the effectiveness of public health interventions.
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Affiliation(s)
- Ani Arzoumanian
- Department of Psychological and Brain Sciences, Colgate University, Hamilton, USA.
| | - Anya Agopian
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Marine Hovhannisyan
- Department of Hygiene and Ecology, Yerevan State Medical University, Yerevan, Armenia
| | - Sharon Chekijian
- Department of Emergency Medicine, Yale School of Medicine, New Haven, USA
| | - Aline Baghdassarian
- Department of Pediatrics, Inova L.J. Murphy Children's Hospital, Falls Church, USA
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Oude Alink M, Moors X, de Bree P, Houmes RJ, den Hartog D, Stolker RJ. Treatment of pediatric patients with traumatic brain injury by Dutch Helicopter Emergency Medical Services (HEMS). PLoS One 2022; 17:e0277528. [PMID: 36584019 PMCID: PMC9803178 DOI: 10.1371/journal.pone.0277528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/30/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Sparse data are available on prehospital care by Helicopter Emergency Medical Service (HEMS) for pediatric patients with traumatic brain injury (TBI). This study focusses on prehospital interventions, neurosurgical interventions and mortality in this group. METHODS We performed a retrospective analysis of pediatric (0-18 years of age) patients with TBI treated by Rotterdam HEMS. RESULTS From January 2012 to December 2017 415 pediatric (<18 years of age) patients with TBI were included. Intubation was required in in 92 of 111 patients with GCS ≤ 8, 92 (82.9%), compared to 12 of 77 (15.6%) with GCS 9-12, and 7 of 199 (3.5%) with GCS 13-15. Hyperosmolar therapy (HSS) was started in 73 patients, 10 with a GCS ≤8. Decompressive surgery was required in 16 (5.8%), nine patients (56.3%) of these received HSS from HEMS. Follow-up data was available in 277 patients. A total of 107 (38.6%) patients were admitted to a (P)ICU. Overall mortality rate was 6.3%(n = 25) all with GCS ≤8, 15 (60.0%) died within 24 hours and 24 (96.0%) within a week. Patients with neurosurgical interventions (N = 16) showed a higher mortality rate (18.0%). CONCLUSIONS The Dutch HEMS provides essential emergency care for pediatric TBI patients, by performing medical procedures outside of regular EMS protocol. Mortality was highest in patients with severe TBI (n = 111) (GCS≤8) and in those who required neurosurgical interventions. Despite a relatively good initial GCS (>8) score, there were patients who required prehospital intubation and HSS. This group will require further investigation to optimize care in the future.
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Affiliation(s)
- Michelle Oude Alink
- Department of Anesthesiology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Xavier Moors
- Department of Anesthesiology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Helicopter Emergency Medical Services, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pim de Bree
- Department of Anesthesiology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Robert Jan Houmes
- Helicopter Emergency Medical Services, Erasmus University Medical Center, Rotterdam, The Netherlands
- Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Dennis den Hartog
- Department of Surgery-Traumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert Jan Stolker
- Department of Anesthesiology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
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Oude Alink MB, Moors XRJ, Karrar S, Houmes RJ, Hartog DD, Stolker RJ. Characteristics, management and outcome of prehospital pediatric emergencies by a Dutch HEMS. Eur J Trauma Emerg Surg 2021; 48:989-998. [PMID: 33543366 PMCID: PMC9001565 DOI: 10.1007/s00068-020-01579-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
Background In prehospital care, the Helicopter Emergency Medical Service (HEMS) can be dispatched for critically injured or ill children. However, little detail is known about dispatches for children, in terms of the incidence of prehospital interventions and overall mortality. The primary objective of this study is to provide an overview of pediatric patient characteristics and incidence of interventions. Methods A retrospective chart review of all patients ≤ 17 years who received medical care by Rotterdam HEMS from 2012 until 2017 was carried out. Results During the study period, 1905 pediatric patients were included. 59.1% of patients were male and mean age was 6.1 years with 53.2% of patients aged ≤ 3 years. 53.6% were traumatic patients and 49.7% were non-traumatic patients. 18.8% of patients were intubated. Surgical procedures were performed in 0.9%. Medication was administered in 58.1% of patients. Cardiopulmonary resuscitation (CPR) was necessary in 12.9% of patients, 19.9% were admitted to the intensive care unit and 14.0% needed mechanical ventilation. Overall mortality was 9.5%. Mortality in trauma patients was 5.5% and in non-trauma group 15.3%. 3.9% of patients died at the scene. Conclusions Patients attended by HEMS are at high risk of prehospital interventions like CPR or intubation. EMS has little exposure to critically ill or injured children. Hence, HEMS expertise is required to perform critical procedures. Trauma patients had higher survival rates than non-traumatic patients. This may be explained by underlying illnesses in non-traumatic patients and CPR as reason for dispatch. Further research is needed to identify options for improving prehospital care in the non trauma pediatric patients.
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Affiliation(s)
- Michelle Berdien Oude Alink
- Department of Anesthesiology, Erasmus University Medical Center-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands. .,Department of Pediatric Anesthesiology, Erasmus University Medical Center Rotterdam-Sophia Children's Hospital, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Xavier Roland Johnny Moors
- Department of Anesthesiology, Erasmus University Medical Center-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands.,HEMS, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Senned Karrar
- Department of Anesthesiology, Erasmus University Medical Center-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Robert Jan Houmes
- HEMS, Erasmus University Medical Center, Rotterdam, The Netherlands.,Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dennis Den Hartog
- Department of Surgery-Traumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert Jan Stolker
- Department of Anesthesiology, Erasmus University Medical Center-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
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Nielsen VML, Kløjgård T, Bruun H, Søvsø MB, Christensen EF. Progression of vital signs during ambulance transport categorised by a paediatric triage model: a population-based historical cohort study. BMJ Open 2020; 10:e042401. [PMID: 33257494 PMCID: PMC7705491 DOI: 10.1136/bmjopen-2020-042401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To examine the severity and progression of acute illness or injury in children using vital signs obtained during ambulance transport and categorised according to a paediatric triage model. DESIGN A population-based historical cohort study using data from prehospital patient medical records linked to a national civil registration database. SETTING Emergency medical services providing ground-level transport in a mixed urban-rural region with three hospitals in Denmark. PARTICIPANTS 25 039 events with patients aged <18 years attended by emergency medical services dispatched after a 1-1-2 emergency call during the years 2006-2018. PRIMARY AND SECONDARY OUTCOME MEASURES Distribution of the first observed vital signs according to a paediatric triage model: heart rate, Glasgow Coma Score, respiratory rate, oxygen saturation and oxygen treatment, and proportion of patients progressing to a triage score with a lower level of urgency during ambulance transport. RESULTS The proportion of patients with the first observed vital signs outside the normal age-specific range was as follows: 33.6% for heart rate, 15.3% for Glasgow Coma Score, 17.4% for respiratory rate and 37.4% for oxygen saturation regardless of oxygen treatment. The proportion of patients progressing to a triage score with a lower level of urgency during transport varied with age: 146/354 (41.2%) for age 0-2 months, 440/986 (44.6%) for age 3-11 months, 1278/3212 (39.8%) for age 1-2 years, 967/2814 (34.4%) for age 3-7 years and 4029/13 864 (29.1%) for age 8-17 years (p<0.001). One-day mortality was 3.05 deaths per 1000 patient-days (95% CI 2.43 to 3.83). CONCLUSIONS One third of the patients' condition progressed to a triage score with a lower level of urgency during ambulance transport. Vital sign documentation in paediatric patients was incomplete, and educational initiatives should be taken to increase documentation of vital signs, especially in patients aged ≤2 years.
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Affiliation(s)
- Vibe Maria Laden Nielsen
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Torben Kløjgård
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Bruun
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg, Denmark
| | - Morten Breinholt Søvsø
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg, Denmark
- Prehospital Emergency Medical Services, North Denmark Region, Denmark
| | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Emergency Department and Trauma Centre, Aalborg University Hospital, Aalborg, Denmark
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Overgaard MF, Heino A, Andersen SA, Thomas O, Holmén J, Mikkelsen S. Physician staffed emergency medical service for children: a retrospective population-based registry cohort study in Odense region, Southern Denmark. BMJ Open 2020; 10:e037567. [PMID: 32792443 PMCID: PMC7430407 DOI: 10.1136/bmjopen-2020-037567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study is to determine diagnostic patterns in the prehospital paediatric population, age distribution, the level of monitoring and the treatment initiated in the prehospital paediatric case. Hypothesis was that advanced prehospital interventions are rare in the paediatric patient population. SETTING We performed a retrospective population-based registry cohort study of children attended by a physician-staffed emergency medical service (EMS) unit (P-EMS), in the Odense area of Denmark during a 10-year study period. PARTICIPANTS We screened 44 882 EMS contacts and included 5043 children. Patient characteristics, monitoring and interventions performed by the P-EMS crews were determined. RESULTS We found that paediatric patients were a minority among patients attended by P-EMS units: 11.2% (10.9 to 11.5) (95% CI) of patients were children. The majority of the children were <5 years old; one-third being <2 years old. Respiratory problems, traffic accidents and febrile seizures were the three most common dispatch codes. Oxygen supplementation, intravenous access and application of a cervical collar were the three most common interventions. Oxygen saturation and heart rate were documented in more than half of the cases, but more than one-third of the children had no vital parameters documented. Only 22% of the children had respiratory rate, saturation, heart rate and blood pressure documented. Prehospital invasive procedures such as tracheal intubation (n=74), intraosseous access (n=22) and chest drainage (n=2) were infrequently performed. CONCLUSION Prehospital paediatric contacts are uncommon, more frequently involving smaller children. Monitoring or at least documentation of basic vital parameters is infrequent and may be an area for improvement. Advanced and potentially life-saving prehospital interventions provide a dilemma since these likely occur too infrequently to allow service providers to maintain their technical skills working solely in the prehospital environment.
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Affiliation(s)
- Morten Føhrby Overgaard
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
- Department of Anaesthesia and Intensive Care Medicine, The Hospital of South West Jutland, Esbjerg, Denmark
| | - Anssi Heino
- Department of Perioperative Services, Intensive Care Medicine and Pain management, Turku University Hospital, Turku Finnish University Association, Turku, Finland
| | - Sofie Allerød Andersen
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
| | - Owain Thomas
- Paediatric Anesthesia and Intensive Care, Skåne University Hospital Lund, Lund, Skåne, Sweden
- Institution of Clinical Sciences, Lund University, Lund, Sweden
| | - Johan Holmén
- Pediatric Anesthesia and Intensive Care, Department of Prehospital and Emergency Care, Queen Silvia's Children's Hospital, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Søren Mikkelsen
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
- Mobile Emergency Care Unit, Odense University Hospital, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Meta-Analysis of Failure of Prehospital Endotracheal Intubation in Pediatric Patients. Emerg Med Int 2020; 2020:7012508. [PMID: 32455022 PMCID: PMC7212286 DOI: 10.1155/2020/7012508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/07/2020] [Indexed: 11/17/2022] Open
Abstract
Prehospital care is essential for airway preservation in pediatric patients who require early endotracheal intubation to improve oxygenation and prevent aspiration. However, high frequencies of failure of endotracheal intubation have been reported for this age group. We aimed to analyze the frequency of failure of endotracheal intubation in pediatric patients within a prehospital context and compare it with adult patients. Thus, a systematic revision of literature with a meta-analysis was performed using a study search and selection strategy ensuring extensiveness, sensitivity, and reproducibility. Meta-analyses were performed for odds ratio, DerSimonian and Laird's Q test was used to assess heterogeneity, and Egger and Begg's test was used to assess publication bias. Overall, 17 papers and 8772 patients were included, and the main cause of prehospital care was assessed to be trauma. Failed endotracheal intubation frequency was 0.4%–52.6% in pediatric patients. The most frequent complication was with esophageal intubation. Forest plot suggests that risk of failure during intubation of pediatric patients is 3.54 fold higher than that observed for adults. It was concluded that airway management in pediatric patients within a prehospital context is a challenge for prehospital care providers because it entails clear physiological and anatomical differences and a low frequency of exposure to this kind of events as opposed to adults. These differences support a widely higher risk of failure of intubation, suggesting the necessity of consistently trained prehospital care providers to ensure proficiency in technique as well as availability of the required equipment.
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Garner AA, Bennett N, Weatherall A, Lee A. Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:149. [PMID: 32295610 PMCID: PMC7161251 DOI: 10.1186/s13054-020-02865-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 03/31/2020] [Indexed: 12/18/2022]
Abstract
Background Clinical team composition for prehospital paediatric intubation may affect success and complication rates. We performed a systematic review and meta-analysis to determine the success and complication rates by type of clinical team. Methods We searched MEDLINE, EMBASE, and CINAHL for interventional and observational studies describing prehospital intubation attempts in children with overall success, first-pass success, and complication rates. Eligible studies, data extraction, and assessment of risk of bias were assessed independently by two reviewers. We performed a random-effects meta-analysis of proportions. Results Forty studies (1989 to 2019) described three types of clinical teams: non-physician teams with no relaxants (22 studies, n = 7602), non-physician teams with relaxants (12 studies, n = 2185), and physician teams with relaxants (12 studies, n = 1780). Twenty-two (n = 3747) and 18 (n = 7820) studies were at low and moderate risk of bias, respectively. Non-physician teams without relaxants had lower overall intubation success rate (72%, 95% CI 67–76%) than non-physician teams with relaxants (95%, 95% CI 93–98%) and physician teams (99%, 95% CI 97–100%). Physician teams had higher first-pass success rate (91%, 95% CI 86–95%) than non-physicians with (75%, 95% CI 69–81%) and without (55%, 95% CI 48–63%) relaxants. Overall airway complication rate was lower in physician teams (10%, 95% CI 3–22%) than non-physicians with (30%, 95% CI 23–38%) and without (39%, 95% CI 28–51%) relaxants. Conclusion Physician teams had higher rates of intubation success and lower rates of overall airway complications than other team types. Physician prehospital teams should be utilised wherever practicable for critically ill children requiring prehospital intubation.
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Affiliation(s)
- Alan A Garner
- CareFlight Australia, 4 Barden St, Northmead, NSW, 2152, Australia. .,The University of Sydney, Sydney, Australia.
| | | | - Andrew Weatherall
- CareFlight Australia, 4 Barden St, Northmead, NSW, 2152, Australia.,Division of Paediatrics and Child Health, The University of Sydney, Sydney, Australia
| | - Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong.,Hong Kong Branch of The Chinese Cochrane Centre, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Coleman N, Barry T, Tobin H, Conroy N, Bury G. Paediatric airway management and concerns: a survey of advanced paramedics in Ireland. Ir J Med Sci 2018; 188:683-688. [PMID: 30112623 DOI: 10.1007/s11845-018-1887-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/11/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Paediatric airway management is of fundamental importance in the critically unwell child. Pre-hospital paediatric airway management especially endotracheal intubation is however controversial. AIM To explore Irish Advanced Paramedics (APs) training, experience and clinical practice in paediatric airway management as well as to examine clinician attitudes toward this topic. METHODS An anonymous online survey of all graduates of the University College Dublin AP training program (N = 453). RESULTS With duplicates and failed email deliveries excluded a valid sample of 382 individuals was obtained from whom a response rate of 185/382 (48.4%) was achieved. Three quarters of responding APs worked in urban or mixed practice with the remaining minority operating primarily in rural areas. One quarter of responding APs reported formal training in paediatric intubation. Almost 70% of APs had encountered a child requiring significant airway management in the preceding year. However, this was a rare exposure in terms of overall workload. Basic airway adjuncts were used frequently in such circumstances, with endotracheal intubation having been attempted by only a small minority of APs. Lack of practice was identified by many responding APs as a key issue causing concern in terms of paediatric intubation. CONCLUSION Paediatric airway management has key relevance for pre-hospital care in Ireland. The overall frequency of exposure to children who may benefit from definitive airway management is however likely to represent a significant barrier to the acquisition and maintenance of competency. The ongoing practice of pre-hospital paediatric intubation by APs may not justify its risks.
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Affiliation(s)
- Neil Coleman
- UCD Centre for Emergency Medical Science, School of Medicine, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Tomas Barry
- UCD Centre for Emergency Medical Science, School of Medicine, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Helen Tobin
- UCD Centre for Emergency Medical Science, School of Medicine, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Niall Conroy
- UCD Centre for Emergency Medical Science, School of Medicine, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Gerard Bury
- UCD Centre for Emergency Medical Science, School of Medicine, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
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Andersen K, Mikkelsen S, Jørgensen G, Zwisler ST. Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre: a retrospective, observational study. Scand J Trauma Resusc Emerg Med 2018; 26:2. [PMID: 29304841 PMCID: PMC5756442 DOI: 10.1186/s13049-017-0470-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. METHODS We performed a retrospective, observational study on paediatric medical emergency calls managed by the EMDC in the Region of Southern Denmark in February 2016. We reviewed audio recordings of emergency calls and ambulance records to identify calls concerning patients ≤ 15 years. We examined EMDC dispatch records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. RESULTS Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15 years. We excluded 19 and analysed the remaining 466. The reported medical issues were commonly classified as: "seizures" (22.1%), "sick child" (18.9%) and "unclear problem" (12.9%). The overall most common pre-hospital response was immediate dispatch of an ambulance with sirens and lights with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. DISCUSSION We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered medical issues, such as the symptoms and conditions pertaining to the symptom categories "seizures" and "sick child". Furthermore, the results could prove useful in hypothesis generation for future studies examining paediatric medical emergency calls. CONCLUSION Almost 7% of all calls concerned patients ≤ 15 years. Medical issues pertaining to the symptom categories "seizures", "sick child" and "unclear problem" were common and the calls commonly resulted in urgent pre-hospital responses.
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Affiliation(s)
- Kasper Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Department of Anaesthesiology & Intensive Care, Odense University Hospital, Odense, Denmark.
| | - Søren Mikkelsen
- Department of Anaesthesiology & Intensive Care, Odense University Hospital, Odense, Denmark.,Department of Anaesthesiology & Intensive Care, Mobile Emergency Care Unit, Odense University Hospital, Odense, Denmark.,Department of Clinical Medicine, Centre for Pre-hospital and Emergency Research, Aalborg University, Aalborg, Denmark
| | - Gitte Jørgensen
- Department of Anaesthesiology & Intensive Care, Mobile Emergency Care Unit, Odense University Hospital, Odense, Denmark.,Emergency Medical Dispatch Centre, Region of Southern Denmark, Odense, Denmark
| | - Stine Thorhauge Zwisler
- Department of Anaesthesiology & Intensive Care, Odense University Hospital, Odense, Denmark.,Department of Anaesthesiology & Intensive Care, Mobile Emergency Care Unit, Odense University Hospital, Odense, Denmark.,Emergency Medical Dispatch Centre, Region of Southern Denmark, Odense, Denmark
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