COMPLEXITY OF PEDIATRIC CHRONIC DISEASE: CROSS-SECTIONAL STUDY WITH 16,237 PATIENTS FOLLOWED BY MULTIPLE MEDICAL SPECIALTIES

IF 1.4 Q3 PEDIATRICS

Revista Paulista De Pediatria Pub Date : 2019-11-25 DOI:10.1590/1984-0462/2020/38/2018101

C. Passone, S. Grisi, S. C. Farhat, T. D. Manna, A. Pastorino, R. A. Alveno, C. V. Miranda, A. R. Waetge, Mariana Nutti Cordon, V. Odone‐Filho, U. Tannuri, W. B. Carvalho, M. Carneiro-Sampaio, C. Silva

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引用次数: 18

Abstract

ABSTRACT Objective: To assess demographic data and characteristics of children and adolescents with pediatric chronic diseases (PCD), according to the number of specialties/patient. Methods: We performed a cross-sectional study with 16,237 PCD patients at outpatient clinics in one year. Data were analyzed by an electronic data system, according to the number of physician appointments for PCD. This study assessed: demographic data, follow-up characteristics, types of medical specialty, diagnosis (International Statistical Classification of Diseases and Related Health Problems - ICD-10), number of day hospital clinic visits, and acute complications. Results: Patients followed by ≥3 specialties simultaneously showed a significantly higher duration of follow-up compared to those followed by ≤2 specialties [2.1 (0.4-16.4) vs. 1.4 (0.1-16.2) years; p<0.001] and a higher number of appointments in all specialties. The most prevalent medical areas in patients followed by ≥3 specialties were: Psychiatry (Odds Ratio - OR=8.0; confidence interval of 95% - 95%CI 6-10.7; p<0.001), Palliative/Pain Care (OR=7.4; 95%CI 5.7-9.7; p<0.001), Infectious Disease (OR=7.0; 95%CI 6.4-7.8; p<0.001) and Nutrology (OR=6.9; 95%CI 5.6-8.4; p<0.001). Logistic regressions demonstrated that PCD patients followed by ≥3 specialties were associated with high risk for: number of appointments/patient (OR=9.2; 95%CI 8.0-10.5; p<0.001), day hospital clinic visits (OR=4.8; 95%CI 3.8-5.9; p<0.001), emergency department visits (OR=3.2; 95%CI 2.9-3.5; p<0.001), hospitalizations (OR=3.0; 95%CI 2.7-3.3; p<0.001), intensive care admissions (OR=2.5; 95%CI 2.1-3.0; p<0.001), and deaths (OR=2.8; 95%CI 1.9-4.0; p<0.001). The diagnosis of asthma, obesity, chronic pain, and transplant was significantly higher in patients followed by ≥3 specialties. Conclusions: The present study showed that PCD patients who required simultaneous care from multiple medical specialties had complex and severe diseases, with specific diagnoses.

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儿科慢性病的复杂性：16237名患者的横断面研究

【摘要】目的:根据儿科慢性病(PCD)的专科/患者数量，评估儿童和青少年的人口学数据和特征。方法:我们对一年内门诊就诊的16237例PCD患者进行了横断面研究。根据PCD的医生预约数量，通过电子数据系统对数据进行分析。这项研究评估了:人口统计数据、随访特征、医学专业类型、诊断(国际疾病和相关健康问题统计分类- ICD-10)、医院门诊日访问量和急性并发症。结果:同时随访≥3个专科的患者随访时间明显高于随访≤2个专科的患者随访时间[2.1 (0.4-16.4)vs. 1.4(0.1-16.2)年;P <0.001]，所有专科的预约次数都更高。患者中最常见的医学领域依次为:精神病学(优势比OR=8.0;置信区间为95% - 95% ci 6-10.7;p<0.001)，姑息/疼痛护理(OR=7.4;95%可信区间5.7 - -9.7;p<0.001)，传染病(OR=7.0;95%可信区间6.4 - -7.8;p<0.001)和营养学(OR=6.9;95%可信区间5.6 - -8.4;p < 0.001)。Logistic回归分析显示，PCD患者接受≥3个专科治疗与以下风险相关:就诊人数/患者(OR=9.2;95%可信区间8.0 - -10.5;p<0.001)，日间医院门诊就诊(OR=4.8;95%可信区间3.8 - -5.9;p<0.001)，急诊科就诊(OR=3.2;95%可信区间2.9 - -3.5;p<0.001)、住院率(OR=3.0;95%可信区间2.7 - -3.3;p<0.001)，重症监护住院(OR=2.5;95%可信区间2.1 - -3.0;p<0.001)和死亡(OR=2.8;95%可信区间1.9 - -4.0;p < 0.001)。哮喘、肥胖、慢性疼痛和移植的诊断率在≥3个专科患者中显著较高。结论:本研究表明，需要多专科同时护理的PCD患者病情复杂严重，诊断具有特殊性。

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来源期刊

Revista Paulista De Pediatria Medicine-Pediatrics, Perinatology and Child Health

CiteScore

2.30

自引率

0.00%

发文量

100

审稿时长

11 weeks

期刊介绍： The Revista Paulista de Pediatria publishes original contributions, case reports and review of clinical research with methodological approach in the areas of health and disease of neonates, infants, children and adolescents. The objective is to disseminate research with methodological quality on issues that comprise the health of children and adolescents. All articles are freely available online, via SciELO. Its abbreviated title is Rev. Paul. Pediatr., which should be used in bibliographies, footnotes and bibliographical references and strips.