在成人重症监护病房接受治疗的儿童中评估儿童死亡率指数。
Evaluation of the Paediatric Index of Mortality in children managed on adult intensive care units.
作者信息
Fraser J, Maskrey C, Taylor H
机构信息
Bristol Children's Hospital, St Michaels's Hill, Bristol, UK.
出版信息
Arch Dis Child. 2004 Oct;89(10):974-6. doi: 10.1136/adc.2003.037614.
OBJECTIVE
To evaluate the performance of the Paediatric Index of Mortality (PIM) in children cared for in adult intensive care units (ICUs) in district general hospitals in the South West Region of England.
DESIGN AND SETTING
An observational survey of all children admitted to adult ICUs in 15 district general hospitals between November 2000 and August 2002. For comparison, data were also collected from the regional paediatric ICUs between November 2000 and March 2002.
RESULTS
Data were collected from 374 children admitted to adult ICUs and 850 children admitted to the regional paediatric ICU. There were significant differences in the patient characteristics between the two groups. In the adult ICU paediatric population, PIM discriminated well between death and survival (Az ROC = 0.96 (95% confidence interval, 0.93 to 0.99)) and calibrated well across deciles of risk (goodness of fit chi2 = 4.55 (8 df), p = 0.8).
CONCLUSIONS
PIM performs well as a risk adjustment method in children whose entire care remains in the adult ICU of a district general hospital. This is important should the Paediatric Intensive Care Audit Network (PICAnet) decide to extend its data collection beyond paediatric intensive care units to other units caring for critically ill children.
目的
评估儿童死亡指数（PIM）在英格兰西南部地区综合医院成人重症监护病房（ICU）中接受治疗的儿童中的表现。
设计与背景
对2000年11月至2002年8月期间15家综合医院成人ICU收治的所有儿童进行观察性调查。为作比较，还收集了2000年11月至2002年3月期间地区儿科ICU的数据。
结果
收集了374名成人ICU收治儿童和850名地区儿科ICU收治儿童的数据。两组患者特征存在显著差异。在成人ICU儿科患者群体中，PIM在死亡和存活之间有良好区分度（曲线下面积（Az ROC）=0.96（95%置信区间，0.93至0.99）），且在各风险十分位数间校准良好（拟合优度卡方=4.55（8自由度），p=0.8）。
结论
在整个治疗过程都在综合医院成人ICU的儿童中，PIM作为一种风险调整方法表现良好。如果儿科重症监护审核网络（PICAnet）决定将其数据收集范围从儿科重症监护病房扩展到其他照顾危重症儿童的病房，这一点很重要。
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