Dean Nathan P, Fenix J B, Spaeder Michael, Levin Amanda
1Division of Critical Care Medicine, Children's National Health System, Washington, DC. 2Division of Critical Care Medicine, George Washington School of Medicine, Washington, DC. 3Department of Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 4Division of Pediatric Critical Care Medicine, University of Virginia School of Medicine, Charlottesville, VA.
Pediatr Crit Care Med. 2017 Jul;18(7):655-660. doi: 10.1097/PCC.0000000000001176.
To evaluate the ability of a Pediatric Early Warning Score to predict deterioration in different subspecialty patient populations.
Single center, retrospective cohort study. Patients were classified into five groups: 1) cardiac; 2) hematology/oncology/bone marrow transplant; 3) surgical; 4) neurologic; and 5) general medical. The relationship between the Pediatric Early Warning Score and unplanned ICU transfer requiring initiation of specific ICU therapies (intubation, high-flow nasal cannula, noninvasive ventilation, inotropes, or aggressive fluid hydration within 12 hr of transfer) was evaluated.
Tertiary care, free-standing, academic children's hospital.
All hospitalized acute care patients admitted over a 6-month time period (September 2012 to March 2013).
None.
During the study time period, 33,800 patient-days and 136 deteriorations were evaluated. Area under the curve ranged from 0.88 (surgical) to 0.94 (cardiac). Sensitivities for a Pediatric Early Warning Score greater than or equal to 3 ranged from 75% (surgical) to 94% (cardiology) and number needed to evaluate to find one deterioration was 11.5 (neurologic) to 43 patients (surgical). Sensitivities for a Pediatric Early Warning Score greater than or equal to 4 ranged from 54% (general medical) to 79% (hematology/oncology/bone marrow transplant) and number needed to evaluate of 5.5 (neurologic) to 12 patients (general medical). Sensitivities for a Pediatric Early Warning Score of greater than or equal to 5 ranged from 25% (surgical) to 58% (hematology/oncology/bone marrow transplant) and number needed to evaluate of 3.5 (cardiac, hematology/oncology/bone marrow transplant, neurologic) to eight patients (surgical).
An elevated Pediatric Early Warning Score is associated with ICU transfer and receipt of ICU-specific interventions in patients across different pediatric subspecialty patient populations.
评估儿科早期预警评分预测不同亚专科患者群体病情恶化的能力。
单中心回顾性队列研究。患者被分为五组：1）心脏科；2）血液学/肿瘤学/骨髓移植科；3）外科；4）神经科；5）普通内科。评估了儿科早期预警评分与需要启动特定重症监护病房治疗（气管插管、高流量鼻导管吸氧、无创通气、使用血管活性药物或在转至重症监护病房后12小时内积极补液）的非计划重症监护病房转归之间的关系。
三级医疗、独立的学术儿童医院。
在6个月期间（2012年9月至2013年3月）收治的所有住院急性病患者。
无。
在研究期间，评估了33800个患者日和136例病情恶化情况。曲线下面积范围为0.88（外科）至0.94（心脏科）。儿科早期预警评分大于或等于3时的敏感度范围为75%（外科）至94%（心脏科），发现一例病情恶化所需评估的患者数量为神经科11.5例至外科43例。儿科早期预警评分大于或等于4时的敏感度范围为54%（普通内科）至79%（血液学/肿瘤学/骨髓移植科），所需评估的患者数量为神经科5.5例至普通内科12例。儿科早期预警评分大于或等于5时的敏感度范围为25%（外科）至58%（血液学/肿瘤学/骨髓移植科），所需评估的患者数量为心脏科、血液学/肿瘤学/骨髓移植科、神经科3.5例至外科8例。
儿科早期预警评分升高与不同儿科亚专科患者群体的重症监护病房转归及接受重症监护病房特定干预措施相关。
