Arnold Meghan A, Chang David C, Nabaweesi Rosemary, Colombani Paul M, Fischer Anne C, Lau Henry T, Abdullah Fizan
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
J Pediatr Surg. 2007 Jun;42(6):950-5; discussion 955-6. doi: 10.1016/j.jpedsurg.2007.01.028.
Gastroschisis is a rare congenital anomaly, the improved surgical management of which has contributed to a survival rate greater than 90%. Development of an accurate risk stratification system to help identify the subset of patients at greatest risk for death may lead to further improvements in outcome.
Infants with gastroschisis were identified from 16 years of the National Inpatient Sample database and the Kids' Inpatient Database using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure code 54.71 (repair of gastroschisis) and an age of less than 8 days. Logistic regression analysis determined which coexisting diagnoses were significantly associated with death. Odds ratios from the logistic regression model were simplified and used as weighting factors to create an additive index. The index was validated using the 2003 Kids' Inpatient Database data set.
Intestinal atresia, necrotizing enterocolitis, rare cardiac anomalies, and lung hypoplasia were strongly associated with death and used to create a scoring system with a potential range of 0 to 10. Every point increase on the scale of gastroschisis risk stratification index is associated with a 95% relative increase in the likelihood of death.
We have developed a novel index, which is superior to previous classification systems in identifying patients with gastroschisis who are at highest risk for death.
腹裂是一种罕见的先天性异常，其手术管理的改进使生存率超过了90%。开发一种准确的风险分层系统以帮助识别死亡风险最高的患者亚组可能会进一步改善治疗结果。
利用国际疾病分类第九版临床修订本程序代码54.71（腹裂修补术）和年龄小于8天，从16年的国家住院样本数据库和儿童住院数据库中识别出腹裂婴儿。逻辑回归分析确定哪些并存诊断与死亡显著相关。将逻辑回归模型中的比值比简化并用作加权因子以创建一个相加指数。该指数使用2003年儿童住院数据库数据集进行验证。
肠闭锁、坏死性小肠结肠炎、罕见心脏异常和肺发育不全与死亡密切相关，并用于创建一个潜在范围为0至10的评分系统。腹裂风险分层指数量表上每增加一分，死亡可能性相对增加95%。
我们开发了一种新的指数，在识别腹裂死亡风险最高的患者方面优于先前的分类系统。
