Deaths In a Non-Trauma Center Pediatric Emergency Department: A Ten-Year Experience

摘要

Background: Although trauma is the leading cause of death in children, there are many pediatric emergency departments that are not trauma centers. To facilitate preparedness for the spectrum of presentations of children who die in non-trauma center PED, we described deaths in such a center over a 10-year period. Methods: Through a retrospective case series, medical records of deaths that occurred in non-trauma center PED from July 1988 to July 1999 were reviewed. Patients were identified by a hospital database and information was extracted from the medical record using a prospectively designed data sheet. Results: Thirty-nine deaths occurred over a ten-year period for an incidence of 1.7 deaths per 10,000 patient visits. The median age of death was 10 months (range: 1 day-22 yrs) with 17 (44%) of the patients being less than 3 months of age. Sudden Infant Death Syndrome (SIDS), confirmed by autopsy, accounted for 12 (31%) of the deaths. Twenty-one (54%) had an underlying chronic medical illness. Median estimated time intervals of onset of arrest to initiation of CPR were 30 minutes (range: 0 mins-7 hrs). Median resuscitative time intervals in the non-trauma center PED were 22 minutes (range: 4 mins-2 hrs 5 mins). Over half (22, 56%) of the patients were resuscitated for greater than 20 minutes. Only one child who presented without vital signs had them briefly restored. Conclusion: When an underlying chronic medical condition did not exist, SIDS was the most common cause of death. We propose that educational programs for the staff of non-trauma center PED directed at the acute counseling of families of SIDS victims would be beneficial. Presented in part at the Southern Society of Pediatric Research Meeting, New Orleans, LA 3/1/00 Introduction Trauma is a threat to the health of American children and is the leading cause of death in children after the first year of life.1 In an attempt to optimize the care of pediatric trauma victims, regionalization of care centers has occurred. One benefit of regionalization is not only the multidisciplinary approach to care of the patient but also the support and counseling that is offered to the family of the victim. Although not documented in the literature, one would assume that members of these teams (dedicated and specially trained nurses, social workers, pastoral care staff) would have specific expertise in dealing with the social, spiritual and grieving components of these unique and difficult situations. Across the United States, there are many pediatric emergency departments (PED) that are not regional trauma centers. Even though the majority of these centers probably are proficient in addressing the spiritual, social and grieving needs of these families whose children have died in the PED, a systematic approach is generally missing and 24-hour-a-day in house support personnel (social worker, pastoral care, etc.) are lacking. In order to facilitate preparedness of non-trauma centers in dealing with families of children who will die in the PED, we sought to identify and describe pediatric deaths that occurred in a non-trauma center PED over a ten-year period. Methods Through a retrospective case series, medical records of deaths that occurred in a mid-Atlantic urban non-trauma center PED, which treated approximately 23,000 patients per year from July 1988-July 1999 were reviewed. Subjects were identified by a hospital disposition database and information was extracted from the medical record using a prospectively designed data sheet by a single investigator (AM). Data collected is summarized on the following data sheet: