Data Sheet 2_Treatment pathways and rebound-rate of prehospital viral croup attacks—data from a prehospital pediatric physician led emergency service—a prospective observational follow-up study.pdf

IntroductionRespiratory illnesses, often caused by upper or lower airway obstruction, represent one of the most common pediatric emergencies. Croup syndrome is the most frequent cause of inspiratory stridor. The study aims to record the incidence, current treatment, and further care measures. Additionally feasibility and suitability of future telemedical consultations for pseudo-croup syndrome should be evaluated.
MethodsA prospective observational follow-up study of children aged 0–18 years who were seen by the Munich physician-led prehospital pediatric emergency service from October 15, 2020 to April 30, 2023. The attending emergency physician completed an anonymous questionnaire with treatment information. The child's parents provided a second questionnaire regarding the clinical course and further care in the 12 h following the initial presentation.
ResultsA total of 226 patients, 154 (68.1%) with a corresponding parental questionnaire, were analysed. The average age was 3.4 years (range 5 months to 9.5 years), with most patients in the toddler (37.6%; n = 85) and early childhood (45.1%, n = 102) age brackets. 8.4% (n = 19) of patients had a, most frequently respiratory (52.6%, n = 10), chronic precondition. The average Westley Score in our cohort was 4.1. Every year increase in age reduces the average Westley score by 21.2% (p = 0.034). Acute therapy consists of steroids rectally (98.2%, n = 222), adrenaline (85.8%, n = 194) and cold/fresh air (78.8%, n = 178) inhalations. 39.8% (n = 90) of patients were transported to the hospital, and a physician accompanied a third (35.6%, n = 32). The strongest predictor for the necessity of physician-accompanied transport was prolonged adrenaline inhalations (OR: 11.25). Nearly ¾ of patients (70.2%, n = 47) were discharged from the emergency department. Of all admitted patients (n = 20), 10% (n = 2) needed intensive care. Out of all patients (n = 226), in 7% (n = 10) of cases with parental information on reoccurrence, a reoccurrence of the croup attack within 12 h was reported.
Conclusion(s)Croup syndrome attacks have a low risk of hospitalisation and rebound. In light of increasingly limited healthcare resources, this study identifies several significant influencing variables for the treatment pathways and proposes a potential treatment algorithm. No patient needed invasive treatments, rendering croup attacks in children a possible target for telemedical consultations with no necessity for on-site physician presence.

引言 呼吸道疾病多由上或下气道梗阻引发，是最为常见的儿科急诊病症之一。哮吼综合征（Croup Syndrome）是引发吸气性喘鸣的最常见病因。本研究旨在记录哮吼综合征的发病率、当前治疗方案及后续照护措施，同时评估未来针对假性哮吼综合征（Pseudo-Croup Syndrome）开展远程医疗问诊的可行性与适宜性。

研究方法 本研究为一项前瞻性观察性随访研究，研究对象为2020年10月15日至2023年4月30日期间，由慕尼黑医师主导的院前儿科急诊服务接诊的0~18岁儿童。接诊的急诊医师需填写包含治疗相关信息的匿名问卷；患儿家长则需填写第二份问卷，内容涉及首次就诊后12小时内的临床病程与后续照护情况。

结果 本研究共纳入226例患儿进行分析，其中154例（68.1%）匹配了对应的家长随访问卷。患儿平均年龄为3.4岁，年龄范围为5个月至9.5岁，多数患儿分布于学步期（37.6%，n=85）与幼儿早期（45.1%，n=102）年龄段。8.4%（n=19）的患儿存在慢性基础疾病，其中最常见的为呼吸系统疾病（52.6%，n=10）。本研究队列的平均威斯利评分（Westley Score）为4.1，患儿年龄每增长1岁，平均威斯利评分降低21.2%（p=0.034）。急诊治疗方案包括经直肠糖皮质激素给药（98.2%，n=222）、肾上腺素（adrenaline）吸入治疗（85.8%，n=194）以及冷/新鲜空气吸入治疗（78.8%，n=178）。39.8%（n=90）的患儿被转运至医院，其中35.6%（n=32）的病例由医师陪同转运。与医师陪同转运必要性相关性最强的预测因素为延长肾上腺素吸入治疗（比值比Odds Ratio：11.25）。近四分之三的患儿（70.2%，n=47）从急诊病房出院。在所有住院患儿（n=20）中，10%（n=2）需要接受重症监护治疗。在226例患儿中，7%（n=10，均有家长提供的复发相关随访信息）报告在首次就诊后12小时内出现哮吼发作复发。

结论 儿童哮吼发作的住院与复发风险均较低。鉴于当前医疗资源愈发紧张，本研究明确了影响治疗路径的多项关键变量，并提出了潜在的治疗算法。本研究中无患儿需要有创治疗，这表明儿童哮吼发作可作为远程医疗问诊的适用场景，无需医师现场出诊。