The association between prehospital vital signs of children and their critical clinical outcomes at hospitals

Kurosawa, Hiroshi; Shiima, Yuko; Miyakoshi, Chisato; Nezu, Mari; Someya, Maki; Yoshida, Minae; Nagase, Hiroaki; Nozu, Kandai; Kosaka, Yoshiyuki; Iijima, Kazumoto

doi:10.1038/s41598-022-09271-0

Cited by 3 publications

(2 citation statements)

References 20 publications

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“…The few previous studies on clinical outcomes for unreferred paediatric EMS populations have reported short term mortality rates comparable to ours (30-day mortality of 0.15-1.60% versus 0.37% in our study) [28][29][30][31].…”

Section: Comparison With Other Studiessupporting

confidence: 85%

Mortality after paediatric emergency calls for patients with or without pre-existing comorbidity: a nationwide population based cohort study

Nielsen,

Søvsø,

Skals

et al. 2024

Scand J Trauma Resusc Emerg Med

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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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Section: Comparison With Other Studiessupporting

confidence: 85%

Mortality after paediatric emergency calls for patients with or without pre-existing comorbidity: a nationwide population based cohort study

Nielsen,

Søvsø,

Skals

et al. 2024

Scand J Trauma Resusc Emerg Med

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“…Vital signs were not always registered independently, as heart rate and SpO 2 would often have been measured simultaneously using a pulse oximeter. Those four vital signs were chosen because of their association with clinical outcomes in paediatric patients in emergency settings [ 16 , 31 , 32 ] and because of their simplicity and mild discomfort for the child. Hypotension is a specific, yet late sign of circulatory failure.…”

Section: Discussionmentioning

confidence: 99%

Prehospital vital sign monitoring in paediatric patients: an interregional study of educational interventions

Nielsen

Søvsø

Kløjgård

et al. 2023

Scand J Trauma Resusc Emerg Med

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Background Prehospital vital sign documentation in paediatric patients is incomplete, especially in patients ≤ 2 years. The aim of the study was to increase vital sign registration in paediatric patients through specific educational initiatives. Methods Prospective quasi-experimental study with interrupted time-series design in the North Denmark and South Denmark regions. The study consecutively included all children aged < 18 years attended by the emergency medical service (EMS) from 1 July 2019 to 31 December 2021. Specific educational initiatives were conducted only in the North Denmark EMS and included video learning and classroom training based on the European Paediatric Advanced Life Support principles. The primary outcome was the proportion of patients who had their respiratory rate, peripheral capillary oxygen saturation, heart rate and level of consciousness recorded at least twice. We used a binomial regression model stratified by age groups to compare proportions of the primary outcome in the pre- and post-intervention periods in each region. Results In North Denmark, 7551 patients were included, while 15,585 patients from South Denmark were used as a reference. Virtually all of the North Denmark EMS providers completed the video learning (98.7%). The total study population involved patients aged ≤ 2 months (5.5%), 3–11 months (7.4%), 1–2 years (18.8%), 3–7 years (16.2%) and ≥ 8 years (52.1%). In the intervention region, the primary outcome increased from the pre- to the post-intervention period from 35.3% to 40.5% [95% CI for difference 3.0;7.4]. There were large variations in between age groups with increases from 18.8% to 27.4% [95% CI for difference 5.3;12.0] among patients aged ≤ 2 years, from 33.5% to 43.7% [95% CI for difference 4.9;15.5] among patients aged 3–7 years and an insignificant increase among patients aged ≥ 8 years (from 46.4% to 47.9% [95% CI for difference − 1.7;4.7]). In the region without the specific educational interventions, proportions were steady for all age groups throughout the entire study period. Conclusions Mandatory educational initiatives for EMS providers were associated with an increase in the extent of vital sign registration in paediatric patients ≤ 7 years. Incomplete vital registration was associated with, but not limited to non-urgent cases.

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Empirically Derived Age-Based Vital Signs for Children in the Out-of-Hospital Setting

Ramgopal

Sepanski

Martin‐Gill

2023

Annals of Emergency Medicine

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The association between prehospital vital signs of children and their critical clinical outcomes at hospitals

Cited by 3 publications

References 20 publications

Mortality after paediatric emergency calls for patients with or without pre-existing comorbidity: a nationwide population based cohort study

Mortality after paediatric emergency calls for patients with or without pre-existing comorbidity: a nationwide population based cohort study

Prehospital vital sign monitoring in paediatric patients: an interregional study of educational interventions

Empirically Derived Age-Based Vital Signs for Children in the Out-of-Hospital Setting

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