Department of Health Sciences, University of Leicester, Leicester, UK.
Paediatr Perinat Epidemiol. 2013 Jul;27(4):426-33. doi: 10.1111/ppe.12053. Epub 2013 Apr 15.
Understanding length of stay for babies in neonatal care is vital for planning services and for counselling parents. While previous work has focused on the length of stay of babies who survive to discharge, when investigating resource use within neonatal care, it is important to also incorporate information on those babies who die while in care. We present an analysis using competing risks methodology which allows the simultaneous modelling of babies who die in neonatal care and those who survive to discharge.
Data were obtained on 2723 babies born at 24-28 weeks gestational age in 2006-10 and admitted to neonatal care. Death and discharge alive are two mutually exclusive events and can be treated as competing risks. A flexible parametric modelling approach was used to analyse these two competing events and obtain estimates of the absolute probabilities of death or discharge.
The absolute probabilities of death or discharge are presented in graphical form showing the cause-specific cumulative incidence over time by gender, gestational age and birthweight. The discharge of babies alive generally occurred over a longer time period for babies of lower gestational age and smaller birthweight than for bigger babies.
This study has presented a useful statistical method for modelling the length of stay where there are significant rates of in-unit mortality. In health care systems that are increasingly focusing on costs and resource planning, it is essential to consider not only length of stay of survivors but also for those patients who die before discharge.
了解新生儿护理中婴儿的住院时间对于规划服务和为家长提供咨询至关重要。虽然之前的研究主要集中在存活至出院的婴儿的住院时间上，但在调查新生儿护理中的资源利用情况时，重要的是还要纳入在护理过程中死亡的婴儿的信息。我们使用竞争风险方法进行了分析，该方法允许同时对在新生儿护理中死亡的婴儿和存活至出院的婴儿进行建模。
我们获得了 2006 年至 2010 年期间在 24-28 周胎龄出生并被收入新生儿护理的 2723 名婴儿的数据。死亡和存活出院是两个互斥事件，可以被视为竞争风险。我们使用灵活的参数建模方法来分析这两个竞争事件，并获得死亡或出院的绝对概率估计。
通过性别、胎龄和出生体重，以图形形式展示了随时间推移的特定原因累积发生率，从而呈现了死亡或出院的绝对概率。与更大的婴儿相比，胎龄和出生体重较低的婴儿存活出院的时间通常更长。
本研究提出了一种有用的统计方法，用于对存在较高单位死亡率的住院时间进行建模。在越来越关注成本和资源规划的医疗保健系统中，不仅要考虑幸存者的住院时间，还要考虑在出院前死亡的患者。
