Berry M A, Shah P S, Brouillette R T, Hellmann J
Department of Pediatrics, Montreal Children's Hospital and McGill University Health Centre, Montreal, QC, Canada.
J Perinatol. 2008 Apr;28(4):297-302. doi: 10.1038/sj.jp.7211904. Epub 2007 Nov 29.
Current scoring systems, which adjust prediction for severity of illness, do not account for higher observed mortality in neonatal intensive care units (NICUs) of children's hospitals than that of perinatal centers. We hypothesized that three potential predictors, (a) admission from another NICU, (b) presence of congenital anomalies and (c) need for surgery, would modify expected mortality and/or length of stay for infants admitted to NICUs in children's hospitals.
We reviewed consecutive admissions to two NICUs in children's hospitals in Canada. We performed regression analyses to evaluate these potential predictors and severity-of-illness indices for the outcomes of mortality and length of stay.
Of 625 neonatal admissions, transfer from another NICU, congenital anomalies requiring admission and surgery were identified in 371 (59%). Using logistic regression, mortality was predicted based on admission from another NICU (odds ratio (OR) 1.92; 95% confidence interval (CI) 1.04, 3.57), congenital anomalies (OR 7.28; 95% CI 3.69, 14.36) and a validated severity-of-illness score, the Score for Neonatal Acute Physiology Perinatal Extension Version II (SNAPPE-II; OR 1.07; 95% CI 1.05, 1.09 per point). By contrast, surgical intervention was predictive of survival (OR 0.35; 95% CI 0.18, 0.67). Length of stay >or=21 days was predicted by SNAPPE-II (OR 1.02; 95% CI 1.01, 1.03 per point), congenital anomalies (OR 2.47; 95% CI 1.60, 3.79) and surgery (OR 2.73; 95% CI 1.77, 4.21).
Fair performance comparisons of NICUs with different case-mixes, such as children's hospital and perinatal NICUs, in addition to severity-of-illness indices, should account for admissions from another NICU, congenital anomalies and surgery.
当前用于调整疾病严重程度预测的评分系统，未考虑儿童医院新生儿重症监护病房（NICU）中观察到的死亡率高于围产期中心这一情况。我们假设三个潜在预测因素，即（a）从另一个NICU转入、（b）存在先天性异常和（c）需要手术，会改变儿童医院NICU收治婴儿的预期死亡率和/或住院时间。
我们回顾了加拿大儿童医院两个NICU的连续入院病例。我们进行回归分析以评估这些潜在预测因素和疾病严重程度指数对死亡率和住院时间结局的影响。
在625例新生儿入院病例中，371例（59%）存在从另一个NICU转入、因先天性异常入院和需要手术的情况。使用逻辑回归分析，基于从另一个NICU转入（比值比（OR）1.92；95%置信区间（CI）1.04，3.57）、先天性异常（OR 7.28；95% CI 3.69，14.36）以及经过验证的疾病严重程度评分——新生儿急性生理学围产期扩展版II评分（SNAPPE-II；每分OR 1.07；95% CI 1.05，1.09）来预测死亡率。相比之下，手术干预是生存的预测因素（OR 0.35；95% CI 0.18，0.67）。SNAPPE-II（每分OR 1.02；95% CI 1.01，1.03）、先天性异常（OR 2.47；95% CI 1.60，3.79）和手术（OR 2.73；95% CI 1.77，4.21）可预测住院时间≥21天。
对于病例组合不同的NICU（如儿童医院的NICU和围产期NICU）进行公平的性能比较时，除了疾病严重程度指数外，还应考虑从另一个NICU转入、先天性异常和手术情况。
