Consensus Minimal Dataset for Pediatric Emergency Medicine in Switzerland.

OBJECTIVES Standardized, harmonized data sets generated through routine clinical and administrative documentation can greatly accelerate the generation of evidence to improve patient care. The objective of this study was to define a pediatric emergency medicine (PEM) minimal dataset for Switzerland (Swiss PEM minimal dataset) and to contribute a subspecialty module to a national pediatric data harmonization process (SwissPedData). METHODS We completed a modified Delphi survey, inviting experts from all major Swiss pediatric emergency departments (PEDs). RESULTS Twelve experts from 10 Swiss PEDs, through 3 Delphi survey rounds and a moderated e-mail discussion, suggested a subspecialty module for PEM to complement the newly developed SwissPedData main common data model (CDM). The PEM subspecialty CDM contains 28 common data elements (CDEs) specific to PEM. Additional CDEs cover PEM-specific admission processes (type of arrival), timestamps (time of death), greater details on investigations and treatments received at the PED, and PEM procedures (eg, procedural sedation). In addition to the 28 CDEs specific to PEM, 43 items from the SwissPedData main CDM were selected to create a Swiss PEM minimal dataset. The final Swiss PEM minimal dataset was similar in scope and content to the registry of the Pediatric Emergency Care Applied Research Network. CONCLUSIONS A practical minimal dataset for PEM in Switzerland was developed through recognized consensus methodology. The Swiss PEM minimal dataset developed by Swiss PEM experts will facilitate international data sharing for PEM research and quality improvement projects

Characteristics of low-acuity paediatric emergency department consultations in two tertiary hospitals in Switzerland

Contexte Les consultations dans les services d’urgences pédiatriques pour raisons non-urgentes sont fréquentes dans les pays à revenus élevés, y compris en Suisse. Ces consultations représentent une charge croissante pour les systèmes de santé et peuvent impacter la qualité des soins. En Suisse, il existe peu de données sur les consultations aux urgences pédiatriques pour raison non-urgente. Cette étude présente la fréquence et les caractéristiques de ces consultations dans les urgences pédiatriques de deux régions suisses. Méthodes Nous avons mené une étude rétrospective dans les services d’urgences pédiatriques de deux hôpitaux suisses universitaires (Berne et Lausanne). Nous avons extrait les données administratives et médicales standardisées depuis les dossiers médicaux informatisés de toutes les consultations aux urgences pédiatriques d'enfants et adolescents âgés de 0 à 17 ans ayant eu lieu entre janvier et décembre 2018. Nous avons défini les consultations pour raison non-urgente comme celles répondant à tous les critères suivants : (1) catégorie de tri 4 ou 5 sur l'échelle de triage australasienne, (2) aucun examen radiologique ou de laboratoire effectué et (3) retour à domicile après la consultation. Nous avons utilisé un modèle de régression logistique multiple binaire pour identifier les facteurs associés aux consultations pour raison non-urgente. Résultats Nous avons analysé 53’089 consultations aux urgences pédiatriques. La proportion de consultations pour raison non-urgente était de 54% (IC 95% 53% à 54%, 28’556 visites). Les consultations pour raisons non-urgentes étaient associées à un âge inférieur à 5 ans (OR ajusté, aOR 1,87, IC 95 % 1,81 à 1,94), au fait de vivre dans un rayon de 5 km du service d’urgences pédiatriques (aOR 1,27, IC 95 % 1,22 à 1,32), et à des présentations en dehors des heures ouvrables (week-end : aOR 1,14, IC 95 % 1,10 à 1,18, nuit : aOR 1,10, IC 95 % 1,23 à 1,36). Conclusion Les consultations pour raison non-urgentes sont fréquentes dans les services d’urgences pédiatriques suisses étudiés. Elles sont associées à un âge plus jeune de l’enfant et à des facteurs de convenance (proximité du domicile et présentations en dehors des heures ouvrables). Cela révèle une demande importante de services proposant des consultations pédiatriques le jour même et avec des horaires étendus en Suisse, offre actuellement non proposée par le système de santé primaire

Characteristics of low-acuity paediatric emergency department consultations in two tertiary hospitals in Switzerland: a retrospective observational study

Background Low-acuity paediatric emergency department (PED) visits are common in high-income countries and are an increasing burden for the healthcare system and quality of care. Little is known about low-acuity PED visits in Switzerland. This study shows frequency and characteristics of such visits in two large PEDs in German-speaking and French-speaking regions of Switzerland. Methods We conducted a retrospective observational study in the PED of two Swiss tertiary care hospitals, Bern and Lausanne. We extracted standardised administrative and medical data from the clinic information system for all PED visits of children aged 0–17 years from January to December 2018. We defined low-acuity visits as those meeting all of the following criteria: (1) triage category 4 or 5 on the Australasian Triage Scale, (2) no imaging or laboratory test performed and (3) discharge home. We used a binary multiple logistic regression model to identify factors associated with low-acuity visits. Results We analysed 53 089 PED visits. The proportion of low-acuity visits was 54% (95% CI 53% to 54%, 28 556 visits). Low-acuity visits were associated with age younger than 5 years (adjusted OR, aOR 1.87, 95% CI 1.81 to 1.94), living within a 5 km radius of PED (aOR 1.27, 95% CI 1.22 to 1.32), and after hour presentations (weekends: aOR 1.14, 95% CI 1.10 to 1.18, nights: aOR 1.10, 95% CI 1.23 to 1.36). Conclusion Low-acuity visits are frequent in our PEDs and associated with younger age and convenience factors (proximity of residency and after hour presentation), pointing to a high demand for paediatric urgent care services in Switzerland not currently covered by the primary healthcare system

Rotavirus disease and health care utilisation among children under 5 years of age in highly developed countries: A systematic review and meta-analysis.

BACKGROUND Rotavirus (RV) infection is the leading cause of diarrhoea-associated morbidity and mortality globally among children under 5 years of age. RV vaccination is available, but has not been implemented in many national immunisation plans, especially in highly developed countries. This systematic review aimed to estimate the prevalence and incidence of health care use for RV gastroenteritis (RVGE) among children aged under 5 years in highly developed countries without routine RV vaccination. METHODS We searched MEDLINE and Embase databases from January 1st 2000 to December 17th 2018 for publications reporting on incidence or prevalence of RVGE-related health care use in children below 5 years of age: primary care and emergency department (ED) visits, hospitalisations, nosocomial infections and deaths. We included only studies with laboratory-confirmed RV infection, undertaken in highly developed countries with no RV routine vaccination plans. We used random effects meta-analysis to generate summary estimates with 95% confidence intervals (CI) and prediction intervals. RESULTS We screened 4033 abstracts and included 74 studies from 21 countries. Average incidence rates of RVGE per 100 000 person-years were: 2484 (95% CI 697-5366) primary care visits, 1890 (1597-2207) ED visits, 500 (422-584) hospitalisations, 34 (20-51) nosocomial infections and 0.04 (0.02-0.07) deaths. Average proportions of cases of acute gastroenteritis caused by RV were: 21% (95% CI 16-26%) for primary care visits; 32% (25-38%) for ED visits; 41% (36-47%) for hospitalisations, 29% (25-34%) for nosocomial infections and 12% (8-18%) for deaths. Results varied widely between and within countries, and heterogeneity was high (I2 > 90%) in most models. CONCLUSION RV in children under 5 years causes many healthcare visits and hospitalisations, with low mortality, in highly developed countries without routine RV vaccination. The health care use estimates for RVGE obtained by this study can be used to model RV vaccine cost-effectiveness in highly developed countries

Hépatite B chez les patients migrants

L’hépatite B chronique touche plus de 3,5% de la population mondiale. Les hépatites virales sont responsables de 1,34 million de décès par an, plus que le nombre de décès dus au VIH. Les migrants, et en particulier les requérants d’asile, font partie d’une population à risque d’être infectée puisque la plupart viennent de pays à moyenne ou haute endémicité. Pourtant, jusqu’à récemment, aucun canton suisse ne proposait de dépistage systématique de l’hépatite B alors même que le combat contre les hépatites virales fait partie des objectifs de développement durable de l’Agenda 2030 des Nations unies, que la Suisse est également appelée à atteindre. Sur la base d’une enquête bidirectionnelle chez des requérants d’asile du canton de Vaud, le taux de positivité pour les Ac anti-HBc est estimé à 42% et celui des AgHBs à 8%. À la lumière de ces données, une stratégie de dépistage systématique a ainsi été implantée dans le canton de Vaud en 2014 afin de permettre l’identification des migrants infectés et leur prise en charge, dans le but de diminuer les complications ainsi que la transmission du virus entre migrants et à la population locale

SwissPedData: Standardising hospital records for the benefit of paediatric research

Background Improvement of paediatric healthcare is hampered by inefficient processes of generating new evidence. Clinical research often requires extra encounters with patients, is costly, takes place in an artificial situation with a biased selection of patients, and entails long delays until new evidence is implemented into health care. Electronic health records (EHR) contain detailed information on real patients and cover the entirety of patients. However, the use of EHR for research is limited because they are not standardized between hospitals. This leads to disproportionate amounts of work for extracting data of interest and frequently data are incomplete and of poor quality. Aims SwissPedData aims to lay the foundation for a paediatric learning health system in Switzerland by facilitating EHR-based research. In this project, we aimed to assess the way routine clinical data are currently recorded in large paediatric clinics in Switzerland and to develop a national EHR-based common data model (CDM) that covers all processes of routine paediatric care in hospitals. Methods A taskforce of paediatricians from large Swiss children's hospitals reviewed the current status of routine data documentation in paediatric clinical care and the extent of digitalization. We then used a modified Delphi method to reach a broad consensus on a national EHR-based CDM. Results All Swiss children's hospitals use EHR to document some or all aspects of care. 119 paediatricians, representing eight hospitals and all paediatric subspecialties, participated in an extended Delphi process to create SwissPedData. The group agreed on a national CDM that comprises a main module with general paediatric data and sub-modules relevant to paediatric subspecialties. The data dictionary includes 336 common data elements (CDEs): 76 in the main module on general paediatrics and between 11 and 59 CDEs per subspecialty module. Among these, 266 were classified as mandatory, 52 as recommended and 18 as optional. Conclusion SwissPedData is a CDM for information to be collected in EHR of Swiss children's hospitals. It covers all care processes including clinical and paraclinical assessment, diagnosis, treatment, disposition and care site. All participating hospitals agreed to implement SwissPedData in their clinical routine and clinic information systems. This will pave the way for a national paediatric learning health system in Switzerland that enables fast and efficient answers to urgent clinical questions by facilitating high-quality nationwide retrospective and prospective observational studies and recruitment of patients for nested prospective studies and clinical trials

Clinical data for paediatric research: the Swiss approach [meeting report].

Continuous improvement of health and healthcare system is hampered by inefficient processes of generating new evidence, particularly in the case of rare diseases and paediatrics. Currently, most evidence is generated through specific research projects, which typically require extra encounters with patients, are costly and entail long delays between the recognition of specific needs in ealthcare and the generation of necessary evidence to address those needs. The Swiss Personalised Health Network (SPHN) aims to improve the use of data obtained during routine healthcare encounters by harmonizing data across Switzerland and facilitating accessibility for research. The project “Harmonising the collection of health-related data and biospecimens in paediatric hospitals throughout Switzerland (SwissPedData)” was an infrastructure development project funded by the SPHN, which aimed to identify and describe available data on child health in Switzerland and to agree on a standardised core dataset for electronic health records across all paediatric teaching hospitals. Here, we describe the results of a two-day symposium that aimed to summarise what had been achieved in the SwissPedData project, to put it in an international context, and to discuss the next steps for a sustainable future. The target audience included clinicians and researchers who produce and use health-related data on children in Switzerland