European journal of pediatrics
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Delivery of paediatric primary care by call centres has emerged as a satisfactory system. It has been reported in the literature in the United States and Australia. European public-funded paediatric emergency departments (ED) have little epidemiological data to rely on to match the demand in care. Since 1996, we have run a free nurse-led after-hours paediatric telephone triage and advice (TTA) system. To determine whether other Swiss public paediatric departments practiced formal TTA, we conducted a nation-wide postal survey. To delineate who used our call centre and for what reasons, we embarked on a retrospective study of all the 1997/2000 calls. Most of the units run a TTA (27/35) but few specifically train their staff (14/27). A 43% increase in call numbers was seen between 1997 (3242) and 2000 (4628). During week-days, most of the calls were between 6 and 11 pm and at weekends, a mid morning activity peak was seen. Some 75% of calls were for children aged 5 years or less. Fever, earache and cough accounted for 42% of the main complaints. Of all calls, 27% were dealt by nurses' advice only. About 15% of the calls were transferred to the on-call resident. About 50% led to a same day ED appointment. ⋯ Nurse-led paediatric telephone triage and advice is common in Switzerland where training seems to be irregular. Our data can help units to better plan an eventual paediatric telephone triage and advice service.
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Intensive front-line protocols have improved survival in children with malignancies; however, intensive multimodal therapy of paediatric malignancies can be associated with a significant risk of serious adverse events. Common risk scores (PRISM, PRISM III, APACHE-II) fail to predict mortality in these patients. A retrospective chart analysis of 32 paediatric cancer patients admitted to the Paediatric Intensive Care Unit (PICU) at the University Hospital of Saarland between January 2001 and December 2003 for life-threatening complications was performed. The aim of this study was to assess risk factors for short-term outcome (survival vs. non-survival when leaving the PICU) and to develop a risk score to estimate outcome in these patients. Overall survival was good (25 of 32 patients). Mortality rate was significantly related to leukaemia/lymphoma ( P = 0.029), to the number of organ failures ( P < 0.0001), neutropenia ( P = 0.001), septic shock ( P = 0.025), mechanical ventilation ( P = 0.01) and inotropic support ( P = 0.01). Employing multiple logistic regression, the strongest predictor for poor outcome was the number of organ failures ( P < 0.05). A risk score (cut-off value: >3 points for non-survival) which included the following risk factors (non-solid tumour, number of organ failures ( n > 2), neutropenia, septic shock, mechanical ventilation, and inotropic medication) yielded a sensitivity of 7/7 (95% CI: 4.56-7.00), a specificity of 23/25 (95% CI: 18.49-24.75), a positive predictive value of 23/23 (95% CI: 19.80-23.00), and a negative predictive value of 7/9 (95% CI: 3.60-8.74) for the time of admission to the PICU. ⋯ Although our risk of mortality score is of prognostic value in assessing short-term outcome in these patients, prospective validation in a larger study cohort is mandatory. Furthermore, it must be emphasised that this risk score must not be used for decision-making in an individual patient.