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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Survival and Health Care Use After Feeding Tube Placement in Children With Neurologic Impairment
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Survival and Health Care Use After Feeding Tube Placement in Children With Neurologic Impairment

机译：在神经系统损伤的儿童喂养管展示后存活和保健使用

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BACKGROUND AND OBJECTIVES: Children with neurologic impairment (NI) often undergo feeding tube placement for undernutrition or aspiration. We evaluated survival and acute health care use after tube placement in this population. METHODS: This is a population-based exposure-crossover study for which we use linked administrative data from Ontario, Canada. We identified children aged 13 months to 17 years with a diagnosis of NI undergoing primary gastrostomy or gastrojejunostomy tube placement between 1993 and 2015. We determined survival time from procedure until date of death or last clinical encounter and calculated mean weekly rates of unplanned hospital days overall and for reflux-related diagnoses, emergency department visits, and outpatient visits. Rate ratios were estimated from negative binomial generalized estimating equation models adjusting for time and age. RESULTS: Two-year survival after feeding tube placement was 87.4% (95% confidence interval [CI]: 85.2%-89.4%) and 5-year survival was 75.8% (95% CI: 72.8%-78.4%). The adjusted rate ratio comparing weekly rates of unplanned hospital days during the 2 years after versus before tube placement was 0.92 (95% CI: 0.57-1.48). Similarly, rates of reflux-related hospital days, emergency department visits, and outpatient visits were unchanged. Unplanned hospital days were stable within subgroups, although rates across subgroups varied. CONCLUSIONS: Mortality is high among children with NI after feeding tube placement. However, the stability of health care use before and after the procedure suggests that the high mortality may reflect underlying fragility rather than increased risk from nonoral feeding. Further research to inform risk stratification and prognostic accuracy is needed.
机译：背景和目标：具有神经系统损伤（NI）的儿童经常接受饲养管展位，用于营养或抽吸。在该人群中，我们评估了管展示后的存活率和急性医疗保健使用。方法：这是一种基于人口的曝光 - 交叉研究，我们使用加拿大安大略省使用链接的行政数据。我们鉴定了13个月至17年的儿童，诊断1993年至2015年之间的原发性胃术或Gastrojejunostomy管安置诊断。我们确定了从程序中的生存时间直到死亡日期或最后的临床遭遇，并计算平均每周未共志医院日期以及回流相关的诊断，急诊部门访问和门诊访问。估计速率比率从负二项式广义估算方程模型估算调整时间和年龄。结果：饲养管放置后两年存活率为87.4％（95％置信区间[CI]：85.2％-89.4％）和5年生存率为75.8％（95％CI：72.8％-78.4％）。调整后的率比与管置前2年后的两年内的每周率比较为0.92（95％CI：0.57-1.48）。同样，与流回流相关的医院日，急诊部门访问和门诊率不变。虽然亚组的速率变化，但无计划的医院日期在亚组内稳定。结论：喂食管放置后Ni的儿童中死亡率高。然而，该程序前后医疗保健使用的稳定性表明，高死亡率可能反映出潜在的脆弱性，而不是非饲料的风险增加。进一步的研究以提供风险分层和预后准确性。

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