PDF(Pubmed)
Abstract：
Medical overuse poses potential risks to patients and contributes to increasing healthcare costs, pediatric emergency departments (PED) in particular. Often, upper respiratory tract infection (URTI) cases are viral-induced and self-limiting, and they do not require specific investigations or treatment. We conducted a retrospective study from 1 December 2021 to 31 January 2022, thereby aiming to identify the common tests and factors influencing specific diagnostic and treatment decisions for URTI in PED. In total, 307 (74.9%) URTI cases underwent complete blood count (CBC) tests, 312 (76.1%) were subjected to C-reactive protein (CRP) tests, and 110 (26.8%) received urinalysis tests. Patients with a longer duration of fever and a physician\'s suspicion of bacterial infection were more likely to receive CBC, CRP, and/or urinalysis tests (p < 0.05). Moreover, 75.1% of the cases were classified as viral URTIs, 9.8% were bacterial URTIs, and 15.1% were unspecified. Notably, 86 (20.1%) children received antibiotics and antibiotic prescription correlated with age, tonsillitis diagnosis, CRP values higher than 30 mg/L, and a CBC of p < 0.05. Patients triaged in the second or third categories were three times more likely to be observed for 24 h compared to patients with URTI and the fourth triage category (p < 0.05). This study highlights the need for interventions to improve the appropriateness of emergency service utilization, thereby emphasizing the importance of judicious decision making in managing pediatric URTIs.
摘要：
医疗过度使用给患者带来潜在风险，并导致医疗费用增加，尤其是儿科急诊科（PED）。通常,上呼吸道感染（URTI）病例是由病毒引起的，是自限性的，他们不需要具体的调查或治疗。我们从2021年12月1日至2022年1月31日进行了一项回顾性研究，旨在确定影响PED中URTI特定诊断和治疗决策的常见测试和因素。总的来说,307例（74.9%）URTI病例接受了全血细胞计数（CBC）测试，312(76.1%)接受了C反应蛋白(CRP)测试，110人(26.8%)接受了尿液分析测试。发烧持续时间较长且医生怀疑细菌感染的患者更有可能接受CBC，CRP,和/或尿液分析测试(p<0.05)。此外，75.1%的病例被归类为病毒性URTI，9.8%是细菌性URTIs，和15.1%未指定。值得注意的是,86名(20.1%)儿童接受抗生素和抗生素处方与年龄相关，扁桃体炎诊断,CRP值高于30mg/L,并且CBC为p<0.05。与URTI和第四分类类别的患者相比，第二或第三类别的患者在24小时内观察到的可能性是三倍（p<0.05）。这项研究强调了采取干预措施以提高紧急服务利用的适当性的必要性，从而强调明智决策在管理儿科URTIs中的重要性。
