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Five years of outpatient parenteral antibiotic therapy with ceftriaxone in the paediatric emergency department: what clinical features are associated with need for admission?
Emergency Medicine Journal ( IF 3.1 ) Pub Date : 2022-10-01 , DOI: 10.1136/emermed-2021-211928 Benjamin J Scally 1 , Gemma Buxton 2 , Jennifer K Smith 3
Emergency Medicine Journal ( IF 3.1 ) Pub Date : 2022-10-01 , DOI: 10.1136/emermed-2021-211928 Benjamin J Scally 1 , Gemma Buxton 2 , Jennifer K Smith 3
Affiliation
Background More children presenting to Emergency Departments (EDs) with acute infections are now directly referred for outpatient parenteral antibiotic therapy (OPAT). Sparse data exist on what clinical features in these children are associated with OPAT failure. We hypothesised that children who were younger or presented with systemic features of infection would be more likely to need admission. Methods We conducted a service evaluation over a 5-year period (12 September 2015–12 September 2020) at a single UK tertiary centre paediatric ED formally known as the Royal Hospital for Sick Children Edinburgh. All children referred from the ED for OPAT with ceftriaxone were included. OPAT failure was defined as a decision by a senior clinician of need for admission. Univariate statistical testing and multivariate logistic regression modelling were performed. Results 754 children received OPAT in the ED over a 5-year period. 95 children (13%) required admission for inpatient management. Need for admission was independently associated with having a positive blood culture (adjusted OR (aOR) 8.9; 95% CI 1.49 to 47; p=0.01) or an ultrasound performed (aOR 6.8; 95% CI 3.74 to 12.7; p<0.001). We observed no significant association between age and systemic features (fever, white cell count or C reactive protein) with need for admission in our multivariate analysis. Conclusion In children presenting with acute infections to our paediatric ED who were deemed suitable by senior clinicians to be managed using OPAT with ceftriaxone, younger age (above 3 months) and the presence of systemic features were not independently associated with need for admission. Overall, our service was safe and no child came to harm from early ambulation during this evaluation. Data are available upon reasonable request.
中文翻译:
在儿科急诊科使用头孢曲松进行 5 年门诊肠外抗生素治疗:哪些临床特征与入院需要相关?
背景 更多因急性感染到急诊科 (ED) 就诊的儿童现在直接转诊接受门诊肠外抗生素治疗 (OPAT)。关于这些儿童的哪些临床特征与 OPAT 失败相关的数据很少。我们假设年龄较小或有全身感染特征的儿童更有可能需要入院。方法 我们在一个正式称为爱丁堡皇家病童医院的英国三级中心儿科急诊室进行了为期 5 年(2015 年 9 月 12 日至 2020 年 9 月 12 日)的服务评估。包括从 ED 转诊的所有使用头孢曲松进行 OPAT 的儿童。OPAT 失败被定义为需要入院的高级临床医生的决定。进行了单变量统计检验和多变量逻辑回归建模。结果 754 名儿童在 5 年内在 ED 接受了 OPAT。95 名儿童 (13%) 需要住院治疗。是否需要入院与血培养阳性(校正 OR (aOR) 8.9;95% CI 1.49 至 47;p=0.01)或进行超声检查(aOR 6.8;95% CI 3.74 至 12.7;p<0.001)独立相关. 在我们的多变量分析中,我们观察到年龄和全身特征(发热、白细胞计数或 C 反应蛋白)与是否需要入院之间没有显着关联。结 年龄较小(3 个月以上)和全身特征的存在与入院需求无关。总体而言,我们的服务是安全的,在此次评估期间,没有儿童因早期行走而受到伤害。可根据合理要求提供数据。
更新日期:2022-09-20
中文翻译:
在儿科急诊科使用头孢曲松进行 5 年门诊肠外抗生素治疗:哪些临床特征与入院需要相关?
背景 更多因急性感染到急诊科 (ED) 就诊的儿童现在直接转诊接受门诊肠外抗生素治疗 (OPAT)。关于这些儿童的哪些临床特征与 OPAT 失败相关的数据很少。我们假设年龄较小或有全身感染特征的儿童更有可能需要入院。方法 我们在一个正式称为爱丁堡皇家病童医院的英国三级中心儿科急诊室进行了为期 5 年(2015 年 9 月 12 日至 2020 年 9 月 12 日)的服务评估。包括从 ED 转诊的所有使用头孢曲松进行 OPAT 的儿童。OPAT 失败被定义为需要入院的高级临床医生的决定。进行了单变量统计检验和多变量逻辑回归建模。结果 754 名儿童在 5 年内在 ED 接受了 OPAT。95 名儿童 (13%) 需要住院治疗。是否需要入院与血培养阳性(校正 OR (aOR) 8.9;95% CI 1.49 至 47;p=0.01)或进行超声检查(aOR 6.8;95% CI 3.74 至 12.7;p<0.001)独立相关. 在我们的多变量分析中,我们观察到年龄和全身特征(发热、白细胞计数或 C 反应蛋白)与是否需要入院之间没有显着关联。结 年龄较小(3 个月以上)和全身特征的存在与入院需求无关。总体而言,我们的服务是安全的,在此次评估期间,没有儿童因早期行走而受到伤害。可根据合理要求提供数据。