急诊科疑似脱水儿童住院和复诊的预测因素

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI:10.1016/j.jemermed.2024.09.006

Rasha D. Sawaya MD , Sarah S. Abdul-Nabi MD , Ola El Kebbi MD , Hani Tamim PHD , Adonis Wazir MD , Maha Makki BA , Zavi Lakissian MSC, MD , Suhair Sakr BS , Rana Sharara-Chami MD, FAAP

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引用次数: 0

摘要

背景：脱水是儿童急诊科（PED）就诊的主要原因。目的：1)确定PED合并全因脱水患者住院和复诊（RV）的预测因素。2)探讨脱水与血清碳酸氢盐（HCO3）水平的关系。方法：这项单中心前瞻性队列研究纳入了2018年11月至2020年3月在三级中心就诊的18岁以下因任何原因脱水的PED患者。主要结局是住院；次要终点是RV到PED。每次来访均测量HCO3。进行了双变量和多变量分析。结果：共纳入324例患者，其中大多数为轻度脱水（199/324,61%）。其中74例（22.8%）入院，250例（77%）出院，其中25例（10.8%）返回PED。住院的预测因子包括医生估计的脱水>5%(校正优势比[aOR] = 2.9；95% CI: 1.5-5.8)，≥1次静脉（IV）输液(aOR = 5.4；95% CI: 1.2-23.8)、抗生素(aOR = 11.92；95% CI: 3.4-35.5), HCO3≤16 mmol/L (aOR = 4.4；95% ci: 1.3-14.7)。入院患者的平均HCO3水平较低（19.94±3.38 mmol/L vs. 20.98±2.65 mmol/L, p = 0.017）。指标访视时的干粘膜是RV的唯一显著预测因子（12%比35.5%,p = 0.023）。退烧药/镇痛药与RV相关（76% vs. 51.9%, p = 0.03）。胃炎与RV呈负相关（4.0%比22.3%,p = 0.03），但在多变量分析中无显著性差异。结论：在这个PED队列中，我们没有发现RV到PED的预测因子。然而，HCO3≤16 mmol/L、医生估计的脱水>5%、≥1静脉输液和PED抗生素与住院率增加有关。如果重复，这些发现可以帮助临床医生在照顾脱水儿科患者时更快地做出处置决定。

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Predictors of Hospital Admissions and Return Visits in Children with Suspected Dehydration Presenting to the Emergency Department

Background

Dehydration is a primary cause of visits to pediatric emergency departments (PED).

Objectives

1) To identify predictors of hospital admission and return visits (RV) in PED patients with all-cause dehydration. 2) To explore the association between dehydration and serum bicarbonate (HCO₃) levels.

Methods

This single-center prospective cohort study included patients under 18 years with dehydration from any cause, presenting to the PED of a tertiary center from November 2018 to March 2020. The primary outcome was hospital admission; the secondary outcome was RV to the PED. HCO₃ was measured for all visits. Bivariate and multivariate analyses were conducted.

Results

The study included 324 patients: most with mild dehydration (199/324, 61%). Of these, 74 (22.8%) were admitted, while 250 (77%) were discharged, 25 of which (10.8%) returned to the PED. Predictors of hospital admission included physician-estimated dehydration >5% (adjusted odds ratio [aOR] = 2.9; 95% CI: 1.5–5.8), ≥1 intravenous (IV) fluid bolus (aOR = 5.4; 95% CI: 1.2–23.8), antibiotics (aOR = 11.92; 95% CI: 3.4–35.5), and HCO₃ ≤16 mmol/L (aOR = 4.4; 95% CI: 1.3–14.7). Admitted patients had lower mean HCO₃ levels (19.94 ± 3.38 mmol/L vs. 20.98 ± 2.65 mmol/L, p = 0.017). Dry mucous membranes at the index visit were the only significant predictor of RV (12% vs. 35.5%, p = 0.023). Antipyretics/analgesics were associated with RV (76% vs. 51.9%, p = 0.03). Gastritis was inversely associated (4.0% vs. 22.3%, p = 0.03) with RV, but these were nonsignificant in multivariate analysis.

Conclusion

In this PED cohort, we found no predictors for RV to the PED. However, HCO₃ ≤16 mmol/L, physician-estimated dehydration >5%, ≥1 IV fluid bolus, and PED antibiotics were associated with increase hospital admission. If replicated, these findings can help clinicians make faster disposition decisions when caring for dehydrated pediatric patients.

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine