Naslov
A clinical decision rule for triage of children under 5 years of age with hydrocarbon (kerosene) aspiration in developing countries

Autori
Bond, G. Randall ; Pieche, Sergio ; Sonicki, Zdenko ; Gamaluddin, H. ; El Guindi, M ; Sakr, M. ; El Seddawy, A ; Abouzaid, M. ; Youssef, A

Izvornik
Clinical Toxicology (1556-3650) 46 (2008), 3; 222-229

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
Aspiration; Hydrocarbon; Kerosene; Pediatric; Poisoning

Sažetak
Background. Unintended hydrocarbon ingestion is a common reason for pediatric hospitalization in the developing world. Objective. To derive a clinical decision rule, to identify patients likely to require a higher level facility (resource-requiring cases), that can be used at primary health care facilities with limited diagnostic and therapeutic resources. Methods. A prospective study of children 2 to 59 months old presenting to a poison treatment facility within 2 hours of oral hydrocarbon exposure. History and objective signs were recorded at admission and at 6, 12, 24 and, if present, 48 hours. Inclusion in the resource-requiring outcome group required: oxygen saturation lt94% ; any CNS depression ; any treatment with (salbutamol) ; any care in the ICU ; or death. Results. 256 met the inclusion criteria and completed the study. Of these, 170 had a course requiring resources unavailable at most primary health care facilities, and 86 did not. The presence of wheezing, any alteration in consciousness (lethargy or any restlessness), or a rapid respiratory rate for age (RR ≥ 50/min if age lt 12mo, ≥ 40/min if age ≥ 12 mo) at presentation identified 167 of 170 of these patients (sensitivity 0.98). Thirty-six of 86 patients classified as non-resource requiring were correctly identified (specificity 0.42). No combination of clinical symptoms provided better discrimination while preserving sensitivity. Conclusions. This study suggests a triage decision rule based on the presence of wheezing, altered consciousness, or a rapid respiratory rate within 2 hours of hydrocarbon exposure. Such a rule requires validation in other settings.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti, Javno zdravstvo i zdravstvena zaštita

POVEZANOST RADA