Fan Xun-mei
Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital University of Medical Sciences, Beijing 100045, China.
Zhonghua Er Ke Za Zhi. 2003 Aug;41(8):565-9.
To simplify the Pediatric Critical Illness Scoring (PCIS), to evaluate the simplified PCIS and to make the simplified scoring system applicable in the grassroots hospitals.
Totally 1,036 patients were scored by PCIS on 1, 3, 7 and the last (discharged or dead) hospital days. The PCIS has 10 items. The full score is 100. The scores of approximately 100, approximately 80, and approximately 70 represent non-serious, serious, and extremely serious patients' condition. The PaO(2) and pH (2 items), BUN or creatinine (3 items), plasma sodium and potassium (5 items) were deleted from PCIS's 10 items in turn. The remaining 8, 7, and 5 items were applied as new scoring system after the original scores were multiplied by 0.8, 0.7, and 0.5. The simplified PCIS was evaluated by comparing the patients' condition that was assessed by PCIS. The consistency rate of patients' condition that was obtained by using PCIS and simplified PCIS should be over 80%. The mortality of non-serious, serious, and extremely serious groups that were defined by using PCIS and simplified PCIS was observed and compared.
When 2, 3 and 5 items were deleted from the PCIS on d1 scoring the consistency rates of the patients' condition were 82.6%, 80.7%, and 69.9%. While 5 items remained on d1 scoring the consistency rate was lower than 80%. When the same 2, 3 and 5 items were deleted from PCIS on d3, d7 and last scoring, the consistency rates of the patients' condition were 81.5% approximately 97.1%. The PCIS and simplified PCIS had a close correlation (r = 0.629-0.948, P < 0.001). In PCIS the mortality rates of non-serious, serious and extremely serious patients were significantly different. When simplified PCIS was used, the mortality rates of the three groups also had significant differences (chi(2) = 86.13-740.33, P < 0.001). Within a group of patients with the same condition, the mortality rates were not significantly different for PCIS and simplified PCIS. For instance, on d1 and last scoring, the mortality rates of extremely serious patients were 29.8%, 67.3% for PCIS and 30.0%-27.9%, 66.3%-64.4% for simplified PCIS.
When 2 items (PaO(2) and pH) were deleted from d1 PCIS scoring and 5 items (PaO(2) and pH, BUN or creatinine, plasma sodium and potassium) were deleted from d3, d7, and last PCIS scoring, the results of assessment of patients' condition were basically the same as those of PCIS. The consistency rates of PCIS and simplified PCIS were > 80%. When simplified PCIS was applied, mortality rates of non-serious, serious, and extremely serious patients were significantly different that were the same as those of PCIS. In patients with the same condition, the mortality rates were not significantly different between the simplified PCIS and PCIS.
简化儿童危重病评分（PCIS），对简化后的PCIS进行评估，并使简化后的评分系统适用于基层医院。
对1036例患者在住院第1天、第3天、第7天及最后（出院或死亡）1天采用PCIS进行评分。PCIS有10项指标，满分100分。约100分、约80分和约70分分别代表病情不严重、严重和极其严重。依次从PCIS的10项指标中删除动脉血氧分压（PaO₂）和pH值（2项）、血尿素氮或肌酐（3项）、血钠和血钾（5项）。将剩余的8项、7项和5项指标作为新的评分系统，原得分分别乘以0.8、0.7和0.5。通过比较PCIS评估的患者病情来评价简化后的PCIS。使用PCIS和简化后的PCIS得出的患者病情一致率应超过80%。观察并比较使用PCIS和简化后的PCIS定义的病情不严重、严重和极其严重组的死亡率。
在第1天评分时，从PCIS中删除2项、3项和5项指标时，患者病情一致率分别为82.6%、80.7%和69.9%。当第1天评分时保留5项指标，一致率低于80%。在第3天、第7天及最后评分时，从PCIS中删除相同的2项、3项和5项指标时，患者病情一致率为81.5%～97.1%。PCIS与简化后的PCIS密切相关（r = 0.629 - 0.948，P < 0.001）。在PCIS中，病情不严重、严重和极其严重患者的死亡率有显著差异。使用简化后的PCIS时，三组的死亡率也有显著差异（χ² = 86.13 - 740.33，P < 0.001）。在病情相同的一组患者中，PCIS和简化后的PCIS的死亡率无显著差异。例如，在第1天和最后评分时，PCIS中极其严重患者的死亡率为29.8%、67.3%，简化后的PCIS为30.0% - 27.9%、66.3% - 64.4%。
在第1天PCIS评分时删除2项（PaO₂和pH值），在第3天、第7天及最后PCIS评分时删除5项（PaO₂和pH值、血尿素氮或肌酐、血钠和血钾），患者病情评估结果与PCIS基本相同。PCIS与简化后的PCIS一致率> 80%。应用简化后的PCIS时，病情不严重、严重和极其严重患者的死亡率有显著差异，与PCIS相同。在病情相同的患者中，简化后的PCIS与PCIS的死亡率无显著差异。
