Tamburro Robert F, West Nancy K, Piercy Jim, Towner Gregory, Fang Hong-Bin
Division of Critical Care Medicine, St. Jude Children's Research Hospital, the Department of Pediatrics, Le Bonheur Children's Medical Center, University of Tennessee Health Science Center, Memphis, TN 38105-2794, USA.
Pediatr Crit Care Med. 2004 Jan;5(1):35-9. doi: 10.1097/01.PCC.0000102397.34748.92.
To determine whether a unit specific nursing acuity score is useful for assessing patients with cancer admitted to the pediatric intensive care unit.
Prospective, cohort analysis.
The intensive care unit of a tertiary-care pediatric oncology hospital.
A total of 219 patients admitted to the pediatric intensive care unit with a diagnosis of cancer or after hematopoietic stem cell transplantation.
The nursing acuity scores obtained during the second shift after admission were recorded and compared with rates of mortality. These nursing acuity scores were also compared with the Pediatric Risk of Mortality (PRISM III) and Therapeutic Intervention Scoring System (TISS-28) scores recorded during the first day of intensive care unit admission.
Mortality differed across the nursing acuity categories (0%, 7.5%, 20.8%, and 47.4%; p=.0002). TISS-28 and PRISM III scores progressively increased with each increase in the categorical nursing score and differed significantly among these levels (TISS-28, p=.0078; PRISM III, p=.0327). The Spearman correlation coefficients between the nursing score and TISS-28 and PRISM III were 0.432 and 0.285, respectively (p<.0001).
The nursing acuity score accurately predicts survival in pediatric patients with cancer, correlates with established indexes of severity of illness and predictors of mortality, and identifies different mortalities across the nursing acuity categories. Although its predictive value may have been enhanced by the use of a second shift score, these findings suggest that it may be a useful tool in this patient population and affirms the insight of the bedside nurse in assessing severity of illness.
确定单位特定护理 acuity 评分是否有助于评估入住儿科重症监护病房的癌症患者。
前瞻性队列分析。
一家三级儿科肿瘤医院的重症监护病房。
共有 219 名入住儿科重症监护病房的患者，诊断为癌症或造血干细胞移植后。
记录入院后第二个班次获得的护理 acuity 评分，并与死亡率进行比较。这些护理 acuity 评分还与重症监护病房入院第一天记录的儿科死亡风险（PRISM III）和治疗干预评分系统（TISS - 28）评分进行比较。
不同护理 acuity 类别之间的死亡率不同（0%、7.5%、20.8%和 47.4%；p = 0.0002）。随着分类护理评分的每次增加，TISS - 28 和 PRISM III 评分逐渐升高，且在这些水平之间存在显著差异（TISS - 28，p = 0.0078；PRISM III，p = 0.0327）。护理评分与 TISS - 28 和 PRISM III 之间的 Spearman 相关系数分别为 0.432 和 0.285（p < 0.0001）。
护理 acuity 评分准确预测癌症儿科患者的生存率，与既定的疾病严重程度指标和死亡率预测指标相关，并识别不同护理 acuity 类别之间的不同死亡率。尽管使用第二个班次评分可能增强了其预测价值，但这些发现表明它可能是该患者群体中的一个有用工具，并肯定了床边护士在评估疾病严重程度方面的见解。
