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首页> 外文学位 >Knowledge and practice patterns of pediatric critical care attending physicians in the diagnosis and management of acute kidney injury.
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Knowledge and practice patterns of pediatric critical care attending physicians in the diagnosis and management of acute kidney injury.

机译：在急诊肾脏损伤的诊断和管理中，儿科重症监护医生的知识和实践模式。

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摘要

Problem under investigation: Acute kidney injury (AKI) is a frequent problem in children with critical illness which carries significant morbidity and mortality and is increasing in incidence. Significant discrepancies exist between recent advances in AKI research and outcomes for children with AKI. It is unknown if the bedside clinician is aware of these advances and is using or operating with the latest knowledge. The current status of AKI care is not well understood in pediatric critical care.;Objective: This study was performed to examine the variation in the knowledge and practice patterns of pediatric critical care attending physicians in the diagnosis, management, and follow-up of pediatric patients with AKI. Practice patterns were hypothesized to deviate significantly from current national guidelines for AKI management as outlined in the Kidney Disease: Improving Global Outcomes (KDIGO) expert consensus statement in 2012. Associations between degree of adherence to national guidelines and provider or facility characteristics were also investigated to identify target populations for future educational interventions.;Research Design and Methods: An anonymous electronic questionnaire containing 27 items was distributed to attending physicians in pediatric critical care via two international research networks: the Society of Critical Care Medicine and the Pediatric Acute Lung Injury and Sepsis Investigators.;Results: Of the 201 surveys which were started, 170 respondents (85% completion rate) completed more than 50% of the survey and were included in the final analysis. Median total adherence score was 11 (IQR 9-13) out of 25, equivalent to 44% adherence to guidelines. The median knowledge adherence score was 3 out of 10 (IQR2-4) and practice patterns adherence score was 8 out of 15 (IQR 6-9). There were no significant associations between physician experience, pediatric intensive care unit size, nephrology presence or geographic region and AKI knowledge or management performance scores (p-values for comparisons of scores between all demographic variables >0.05). Largest areas of discrepancy between respondents' answers and the guidelines were in questions related to AKI diagnosis, guideline knowledge and use, fluid overload management, and awareness of the long-term implications of AKI. Guideline awareness and use was associated with lower odds of poor AKI performance, OR 0.70 (95%CI 0.51-0.96, p=0.03) and had a significant correlation with practice patterns, rs=0.354, p<0.0001.;Conclusion: Pediatric critical care physicians with all levels of experience, volume of renal replacement therapy, and institution size would benefit from increased education regarding AKI detection and impact. Increasing physician awareness of the limitations of serum creatinine, of the AKI guidelines, of the need for nephrology referral, and of the impact of fluid overload could lessen the burden of pediatric AKI in critically ill children.
机译：研究中的问题：急性肾脏损伤（AKI）是重症儿童的常见问题，其患病率和死亡率均很高，并且发病率也在增加。 AKI研究的最新进展与AKI儿童的结局之间存在显着差异。尚不清楚床边临床医生是否意识到这些进展并正在使用或以最新知识进行操作。儿科重症监护尚未充分了解AKI护理的当前状况。目的：本研究旨在检查在儿科医生的诊断，管理和随访中儿科重症监护的知识和实践模式的差异AKI患者。假设实践模式与2012年《肾脏疾病：改善全球结局（KDIGO）专家共识声明》中概述的当前国家AKI管理指南有很大出入。还对遵守国家指南的程度与提供者或设施特征之间的关联进行了调查，确定目标人群以进行未来的教育干预。研究设计和方法：一项包含27个项目的匿名电子问卷通过两个国际研究网络（重症医学会和小儿急性肺损伤和败血症）分发给了儿科重症监护医师调查人员；结果：在开始的201个调查中，有170位受访者（完成率达到85％）完成了调查的50％以上，并纳入了最终分析。总的依从性得分中位数是25分中的11分（IQR 9-13），相当于对指南的44％依从性。知识依从性中位数为10分中的3分（IQR2-4），实践模式依从性得分为15分中的8分（IQR 6-9）。医师经验，儿科重症监护病房规模，肾病学所在地区或地理区域与AKI知识或管理绩效得分之间没有显着相关性（所有人口统计学变量之间得分比较的P值> 0.05）。受访者的答案与准则之间最大的差异在于与AKI诊断，准则知识和使用，体液超负荷管理以及对AKI的长期影响的认识有关的问题。指南意识和使用与不良AKI表现的几率较低相关，或为0.70（95％CI 0.51-0.96，p = 0.03），并且与实践模式有显着相关性，rs = 0.354，p <0.0001 .;结论：小儿危重具备各种经验，肾脏替代疗法的数量和机构规模的专业护理医生将可以从有关AKI检测和影响的更多教育中受益。医师对血清肌酐水平的局限性，AKI指南，肾病转诊的需要以及体液超负荷的影响的认识不断提高，可以减轻危重儿童的儿科AKI负担。

著录项

  • 作者

    Hassinger, Amanda Brooks.;

  • 作者单位

    State University of New York at Buffalo.;

  • 授予单位 State University of New York at Buffalo.;
  • 学科 Medicine.
  • 学位 M.S.
  • 年度 2015
  • 页码 34 p.
  • 总页数 34
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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