Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287-0005, USA.
Ann Surg. 2010 Jan;251(1):165-70. doi: 10.1097/SLA.0b013e3181b977c4.
The Agency for Healthcare Research and Quality (AHRQ) pediatric quality indicators (PDIs) are measures designed to evaluate the quality of pediatric healthcare. They specifically focus on adverse events that are potentially avoidable, including complications and iatrogenic events. PDI 1 refers to accidental puncture or laceration.
To determine risk factors and outcomes associated with PDI 1 in a population of pediatric surgical patients.
DESIGN, SETTING, AND PATIENTS: The Nationwide Inpatient Sample and Kids Inpatient Database were used to identify hospitalized pediatric surgical patients in the United States (age: 0-18) from 1988 to 2005. The data from these 1,939,540 patients was linked to the AHRQ PDIs using AHRQ WinQI software, and 7,033 pediatric patients with PDI 1 were identified. A 1:3 matched case control design was implemented with 6,459 cases (patients with PDI 1) and 19,377 controls (patients without PDI 1) matched on age, race, gender, and hospital ID. Cases and controls were stratified into procedure categories based on diagnosis related group procedure codes.
To examine the relationship between PDI 1 and procedure category, as well as the outcomes of in-hospital mortality, length of stay, and total hospital charges for cases compared with controls.
Of the 4,627 patients with PDI 1 stratified into procedure categories, the highest proportion of PDI 1 cases occurred in the gastrointestinal (30.19%), cardiothoracic (19.6%), and the orthopedic (11.13%) categories. Logistic regression analysis for PDI 1, controlling for admission type and insurance status, revealed a statistically significant higher odds of PDI 1 in the gynecology (OR: 1.69, P < 0.001) and transplant (OR: 1.45, P: 0.026) procedure categories. Multivariable regression analysis revealed patients with PDI 1 were more likely to die (OR: 1.91, P < 0.001), had a 4.81 day longer length of stay (95% CI: 4.26-5.36, P < 0.001) and had USD 36,291 higher total hospital charges (95% CI: USD 32,583-USD 40,000, P < 0.001) compared with patients without PDI 1.
Cases of PDI 1 were most commonly associated with the gastrointestinal, cardiothoracic, and orthopedic procedure categories, and these were also 3 of the most common procedure categories overall. Controlling for type of procedure and other variables, the procedure categories having the highest likelihood of PDI 1 were gynecology and transplant. PDI 1 was found to be associated with greater mortality, longer length of stay, and greater total hospital charges.
医疗保健研究与质量署（AHRQ）儿科质量指标（PDI）是用于评估儿科医疗保健质量的指标。它们特别关注潜在可预防的不良事件，包括并发症和医源性事件。PDI1 是指意外刺伤或撕裂伤。
确定儿科外科患者人群中与 PDI1 相关的风险因素和结果。
设计、设置和患者：使用全国住院患者样本和儿童住院数据库在美国（年龄：0-18 岁）确定了 1988 年至 2005 年住院的儿科外科患者。使用 AHRQ WinQI 软件将这些 1939540 名患者的数据与 AHRQPDIs 相关联，并确定了 7033 名患有 PDI1 的儿科患者。实施了 1:3 匹配病例对照设计，将 6459 例（患有 PDI1 的病例）和 19377 例（未患有 PDI1 的对照）按年龄、种族、性别和医院 ID 进行匹配。根据诊断相关组手术代码将病例和对照分层为手术类别。
检查 PDI1 与手术类别之间的关系，以及与对照组相比，病例的住院死亡率、住院时间和总住院费用的结果。
在分为手术类别的 4627 名患有 PDI1 的患者中，PDI1 病例的比例最高的是胃肠道（30.19%）、心胸（19.6%）和骨科（11.13%）类别。对 PDI1 进行 logistic 回归分析，控制入院类型和保险状况，发现在妇科（OR：1.69，P<0.001）和移植（OR：1.45，P：0.026）手术类别中，PDI1 的发生几率更高。多变量回归分析显示，患有 PDI1 的患者更有可能死亡（OR：1.91，P<0.001），住院时间延长 4.81 天（95%CI：4.26-5.36，P<0.001），总住院费用增加 36291 美元（95%CI：32583 美元至 40000 美元，P<0.001）与没有 PDI1 的患者相比。
PDI1 病例最常见于胃肠道、心胸和骨科手术类别，这些也是总体上最常见的手术类别。控制手术类型和其他变量，发生 PDI1 可能性最高的手术类别是妇科和移植。PDI1 与更高的死亡率、更长的住院时间和更高的总住院费用相关。
