74 A rural perspective of severe acute respiratory admissions: Clinical characteristics and outcomes of children hospitalized in rural communities from 2022-2023, the READAPT-Kids study cohort
Notice bibliographique
Résumé
Abstract Background As public health guidelines relaxed following the SARS-CoV2 pandemic, the 2022-2023 respiratory viral season brought crisis to Canada’s paediatric hospitals due to a surge in admissions for severe acute respiratory illnesses (SARI). This included the most common reasons for paediatric admissions, such as bronchiolitis, asthma and pneumonia. The effect on rural hospitals was profound, but limited data is available. Children in rural and remote communities may experience greater barriers to care and worse outcomes compared with those in urban centres, but descriptions of their experiences are limited. Objectives To describe transportation pathways, clinical presentations, interventions and outcomes of children admitted to rural and regional hospitals with severe acute respiratory illnesses (SARI) during the 2022-2023 season. Design/Methods An observational cohort study of children and youth less than 18 years hospitalized with SARI from July 1, 2022 to June 30, 2023 at 3 regional hospitals within a single health authority, spanning a geographical area of 600,000 square kilometres. This was a subgroup analysis of the larger READAPT-Kids study cohort (clinical chaRacteristics and outcomEs of hospitAlized chilDren with Acute resPiratory infecTions). Cases were identified using ICD-10-CA codes, then manually screened for inclusion criteria. Detailed clinical, demographic and transport information was extracted. Results A total of 203 children were admitted with SARI to either the regional centre (n=137) or 2 other community hospitals (n=29; n=37) during the study period. Of these admissions, 25% (n=51) were transported from a peripheral site and 3% (n=6) required transport from two or more healthcare facilities before arriving at the final treating hospital. Referring sites included remote health clinics and local community hospitals. 40% (n=82) required significant respiratory support, including high flow nasal cannula oxygen (34%, n=70), BiPAP (3%, n=5) or CPAP (3%, n=5). On admission, 48% (n=98) were prescribed antimicrobial therapy, 10% (n=21) were treated with antivirals, and 67% (n=135) received corticosteroids. A total of 5% (n=10) of children were subsequently transported by air to a provincial paediatric intensive care unit (PICU) for critical care support. Upon discharge, 40% (n=80/197) had scheduled paediatric follow-up. Conclusion Almost half of the children admitted with SARI in northern community hospitals required a significant level of respiratory support, but only 5% required transfer to a PICU for intensive care. Rural and regional centres provide a critical role in caring for paediatric patients. More research is needed to help advocate for this patient population and the healthcare providers caring for them.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».