Schieveld Jan N M, Lousberg Richel, Berghmans Eline, Smeets Inge, Leroy Piet L J M, Vos Gijs D, Nicolai Joost, Leentjens Albert F G, van Os Jim
Department of Psychiatry, University Hospital Maastricht, Maastricht, The Netherlands.
Crit Care Med. 2008 Jun;36(6):1933-6. doi: 10.1097/CCM.0b013e31817cee5d.
Delirium in children is a serious but understudied neuropsychiatric disorder. So there is little to guide the clinician in terms of identifying those at risk.
To study, in a pediatric intensive care unit (PICU), the predictive power of widely used generic pediatric mortality scoring systems in relation to the occurrence of pediatric delirium (PD).
Four-year prospective observational study, 2002-2005. Predictors used were the Pediatric Index of Mortality (PIM) and Pediatric Risk of Mortality (PRISM II).
A tertiary 8-bed PICU in The Netherlands.
877 critically ill children who were acutely, nonelectively, and consecutively admitted.
Pediatric delirium.
Out of 877 children with mean age 4.4 yrs, 40 were diagnosed with PD (Cumulative incidence: 4.5%), 85% of whom (versus 40% with nondelirium) were mechanically ventilated. The area under the curve was 0.74 for PRISM II and 0.71 for the PIM, with optimal cut-off points at the 60th centile (PRISM: sensitivity: 76%; specificity: 62%; PIM: sensitivity: 82%; specificity: 62%). A PRISM II or PIM score above the 60th centile was strongly associated with later PD in terms of relative risk (PRISM II: risk ratio = 4.9; 95% confidence interval: 2.3-10.1; PIM: RR = 6.7; 95% confidence interval: 3.0-15.0). Given the low incidence of PD, values for positive predictive value were lower (PRISM II: 8.3%; PIM: 8.9%, rising to, respectively, 10.1% and 10.6% in mechanically ventilated patients) and values for negative predictive value were higher (PRISM II: 98.3%; PIM: 98.7%).
Given the relatively low incidence of delirium, a low detection rate biased toward the most severe cases cannot be excluded.
Given the fact that PIM and PRISM II are widely used mortality scoring instruments, prospective associations with PD suggest additional value for ruling in, or out, patients at risk of PD.
儿童谵妄是一种严重但研究不足的神经精神障碍。因此，在识别有风险的儿童方面，几乎没有什么能为临床医生提供指导。
在儿科重症监护病房（PICU）中，研究广泛使用的通用儿科死亡率评分系统对小儿谵妄（PD）发生的预测能力。
2002年至2005年进行的为期四年的前瞻性观察研究。使用的预测指标是儿科死亡率指数（PIM）和儿科死亡风险（PRISM II）。
荷兰一家拥有8张床位的三级PICU。
877名急性、非选择性且连续入院的危重症儿童。
小儿谵妄。
在877名平均年龄为4.4岁的儿童中，40名被诊断为PD（累积发病率：4.5%），其中85%（而非谵妄儿童为40%）接受了机械通气。PRISM II的曲线下面积为0.74，PIM为0.71，最佳截断点在第60百分位数（PRISM：敏感性：76%；特异性：62%；PIM：敏感性：82%；特异性：62%）。PRISM II或PIM评分高于第60百分位数与后期PD在相对风险方面密切相关（PRISM II：风险比= 4.9；95%置信区间：2.3 - 10.1；PIM：RR = 6.7；95%置信区间：3.0 - 15.0）。鉴于PD的发病率较低，阳性预测值较低（PRISM II：8.3%；PIM：8.9%，机械通气患者分别升至10.1%和10.6%），阴性预测值较高（PRISM II：98.3%；PIM：98.7%）。
鉴于谵妄的发病率相对较低，不能排除偏向最严重病例的低检出率。
鉴于PIM和PRISM II是广泛使用的死亡率评分工具，与PD的前瞻性关联表明其在判定或排除有PD风险的患者方面具有额外价值。
