单中心儿科门急诊0~16岁儿童10年死亡数据分析

目的 通过回顾性分析首都医科大学附属北京潞河医院急诊0~16岁儿童青少年死亡病例,探讨急诊儿童青少年死亡原因及特点,以期寻找救治急重症儿童,减少急诊儿童死亡的切入点,为降低儿童青少年病死率制定防治策略提供临床依据。方法 从“人口死亡信息登记管理系统”中调取首都医科大学附属北京潞河医院2009年1月至12月期间16岁以下儿童死亡数据,按照不同的年龄段分为新生儿组(≤28 d)、婴儿组(28 d＜年龄≤1岁)、幼儿组(1岁＜年龄≤3岁)、学龄前组(3岁＜年龄≤6岁)、学龄期组(6岁＜年龄≤10岁)、青春期组(10岁＜年龄≤16岁),进行统计和分析。结果 导致儿童青少年死亡的主要原因:意外伤害死亡、猝死、疾病终末期,呼吸衰竭及呼吸、心跳骤停等。死亡原因第一位是意外伤害,占40%;第二位是猝死,占15%;第三位是呼吸衰竭和疾病终末期,各占13%。在意外伤害死亡病例中,男女性别比例为1.86∶1。其中交通伤占首位(42.5%),其次是坠/跌落伤(25.0%)。儿童死亡存在年龄阶段的差异,青春期组以交通伤为主要伤害类型(42.85%),学龄前组、学龄期组和婴儿组以交通伤和坠/跌落伤为主要伤害类型,幼儿组以交通伤(28.57%)和异物(28.57%)为主要伤害类型,其次是坠/跌落伤(14.28%)、溺水(14.28%)及中毒(14.28%)。儿童死亡地点发生在来院途中是第一位占37%,其次是在家中占32%,院前死亡占69%,新生儿期、婴幼儿期儿童发生院前死亡明显高于学龄前期及学龄期组儿童。结论 通州区0~16岁儿童青少年急诊死亡前3位的原因是:意外伤害死亡、猝死、呼吸衰竭及疾病终末期,不同年龄段死亡原因不同,死亡地点多为院前,年龄越小发生院前死亡风险越高,男孩多于女孩。

Analysis of 10-year death data of children aged 0-16 in single-center pediatric outpatient and emergency department

Objective Through retrospective analysis of the cases of children and adolescents from 0 to 16 years old in the Emergency Department of Beijing Luhe Hospital, Capital Medical University, the causes and characteristics of the deaths of children and adolescents in the emergency department were studied, so as to find the entry point for treating children with acute severe diseases and reducing the deaths of children in the emergency department, and provide clinical basis for the development of prevention and treatment strategies for reducing the mortality of children and adolescents. Methods From the “Population Death Information Registration and Management System”, the death data of children under 16 years of age were collected in our hospital from January 2009 to December 2019 and divided into neonatal groups according to different age groups (≤28 days), infant group (>28 days-≤1 year old), children group (>1-≤3 years old), preschool group (>3-≤6 years), school age group (>6 years-≤10 years), and the adolescent group (>10 years old-≤16 years old). Results The main causes of death in children and adolescents were found to be accidental injury death, sudden death, end-stage disease, respiratory failure and respiratory and cardiac arrest. The first cause of death was accidental injury, accounting for 40.00%, followed by sudden death, accounting for 15.00%, followed by respiratory failure and end-stage disease, accounting for 13.00%, respectively. Among unintentional injury deaths, the ratio of males to females was 1.86 to 1. Traffic injuries accounted for the first place (42.50%), followed by fall/fall injuries (25.00%). There were age differences in the death of children, and traffic injury was the main injury type in the adolescent group (42.85%). Traffic injuries and fall/fall injuries were the main injury types in the preschool, school and infant groups, while traffic injuries (28.57%) and foreign bodies (28.57%) were the main injury types in the infant group, followed by fall/fall injuries (14.28%), drowning (14.28%) and poisoning (14.28%). The place where children died on the way to the hospital was the first, followed by 32.00% at home, and the place where children died before the hospital accounted for 69%. The number of children who died before the hospital was significantly higher in the neonatal period and infant period than that of the pre-school and school-age groups. Conclusion The top three causes of death in emergency care for children aged 0-16 years in Tongzhou district were accidental injury death, sudden death, respiratory failure and terminal disease. The causes of death were different in different age groups, and the place of death was mostly pre-hospital. The younger the age was, the higher the risk of pre-hospital death was, and the risk of boys were more than that of girls.