Rubenstein J S, Gomez M A, Rybicki L, Noah Z L
Division of Pediatric Critical Care, Northwestern University Medical School, Chicago, IL.
Crit Care Med. 1992 Dec;20(12):1657-61. doi: 10.1097/00003246-199212000-00009.
To evaluate the quality of objective information obtained during telephone requests for the transport of pediatric patients. To evaluate the ability of subjective judgment, the Pediatric Risk of Mortality (PRISM) score, and the presence of tachycardia for age to predict the need for a physician on as a member of the pediatric transport team.
Prospective data collection.
The pediatric transport program of a children's hospital.
All 129 infants and children transported over a 4-month period.
We defined an objective measure of the need for a physician's presence during the transport of a pediatric patient, based on either the necessity for procedural or medical interventions during the time of transport or on direct admission to the pediatric ICU after transport. At the time of initial telephone contact, a physician's subjective opinion of the need for physician presence was recorded, a PRISM score was derived, and the presence of tachycardia (adjusted for age) was determined. Subsequently, the vital signs recorded on the record of this request were compared with those vital signs charted at the referring hospital at the time of the initial telephone request. A total of 96% of vital signs obtained during the initial telephone contact were consistent with those percentages in the referring hospital medical records. Fifty (39%) of 129 transported patients required procedural or medical interventions or pediatric ICU admission. Subjective judgments predicted physician need with a high sensitivity (0.98), but with a low specificity (0.18). PRISM score predicted 62 (48%) of 129 transports to be "physician-required" (sensitivity = 0.72; specificity = 0.67). There was no statistical association between tachycardia for age and the objective need for a physician's presence.
Objective information obtained during request for transfer was reliable. At the time of request for transfer, subjective judgment, PRISM score, and the presence of tachycardia did not predict the need for a physician presence during transport.
评估在电话请求转运儿科患者过程中获取的客观信息质量。评估主观判断、儿科死亡风险（PRISM）评分以及按年龄调整的心动过速情况预测儿科转运团队中需要医生随行的能力。
前瞻性数据收集。
一家儿童医院的儿科转运项目。
4个月期间转运的所有129名婴儿和儿童。
我们基于转运期间进行程序或医疗干预的必要性或转运后直接入住儿科重症监护病房，定义了一种客观衡量儿科患者转运期间是否需要医生随行的方法。在首次电话联系时，记录医生对是否需要医生随行的主观意见，得出PRISM评分，并确定是否存在（按年龄调整的）心动过速。随后，将此请求记录中的生命体征与首次电话请求时转诊医院记录的生命体征进行比较。首次电话联系期间获得的生命体征中，共有96%与转诊医院病历中的百分比一致。129名转运患者中有50名（39%）需要进行程序或医疗干预或入住儿科重症监护病房。主观判断预测医生需求的敏感性较高（0.98），但特异性较低（0.18）。PRISM评分预测129次转运中有62次（48%）“需要医生”（敏感性 = 0.72；特异性 = 0.67）。按年龄调整的心动过速与客观上需要医生随行之间无统计学关联。
转运请求期间获得的客观信息可靠。在转运请求时，主观判断、PRISM评分和心动过速情况均不能预测转运期间是否需要医生随行。
