Division of Critical Care Medicine, Children's National Medical Center, Washington, DC, USA.
Pediatrics. 2010 Jun;125(6):1208-16. doi: 10.1542/peds.2009-1451. Epub 2010 May 10.
The primary objective of this study was to obtain a broad understanding of inpatient deaths across academic children's hospitals.
A nonconcurrent cohort study of children hospitalized in 37 academic children's hospitals in 2005 was performed. The primary outcome was death. Patient characteristics including age, gender, race, diagnostic grouping, and insurance status and epidemiological measures including standardized mortality rate and standardized mortality ratios (SMRs) were used.
A total of 427 615 patients were discharged during the study period, of whom 4529 (1.1%) died. Neonates had the highest mortality rate (4.03%; odds ratio: 8.66; P < .001), followed by patients >18 years of age (1.4%; odds ratio: 2.86; P < .001). The SMRs ranged from 0.46 (all patient-refined, diagnosis-related group 663, other anemias and disorders of blood) to 30.0 (all patient-refined, diagnosis-related group 383, cellulitis and other bacterial skin infections). When deaths were compared according to institution, there was considerable variability in both the number of children who died and the SMRs at those institutions.
Patient characteristics, such as age, severity, and diagnosis, were all substantive factors associated with the death of children. Opportunities to improve the environment of care by reducing variability within and between hospitals may improve mortality rates for hospitalized children.
本研究的主要目的是广泛了解学术儿童医院的住院患者死亡情况。
对 2005 年在 37 家学术儿童医院住院的儿童进行非同期队列研究。主要结局是死亡。患者特征包括年龄、性别、种族、诊断分组和保险状况，以及流行病学指标，包括标准化死亡率和标准化死亡比（SMR）。
研究期间共有 427615 名患者出院，其中 4529 人（1.1%）死亡。新生儿死亡率最高（4.03%；比值比：8.66；P<.001），其次是 18 岁以上患者（1.4%；比值比：2.86；P<.001）。SMR 范围从 0.46（所有患者细化、诊断相关组 663、其他贫血和血液疾病）到 30.0（所有患者细化、诊断相关组 383、蜂窝织炎和其他细菌性皮肤感染）。按机构比较死亡情况时，死亡儿童人数和该机构的 SMR 均存在相当大的差异。
患者特征，如年龄、严重程度和诊断，都是与儿童死亡相关的实质性因素。通过减少医院内部和之间的变异性来改善护理环境的机会可能会提高住院儿童的死亡率。
