Department of Pediatrics, Indiana University School of Medicine, Indianapolis IN.
Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Indianapolis IN.
Pediatr Crit Care Med. 2018 May;19(5):483-488. doi: 10.1097/PCC.0000000000001521.
To determine the validity of the Bedside Pediatric Early Warning Score system in the hematopoietic cell transplant population, and to determine if the addition of weight gain further strengthens the association with need for PICU admission.
Retrospective cohort study of pediatric allogeneic hematopoietic cell transplant patients from 2009 to 2016. Daily Pediatric Early Warning Score and weights were collected during hospitalization. Logistic regression was used to identify associations between maximum Pediatric Early Warning Score or Pediatric Early Warning Score plus weight gain and the need for PICU intervention. The primary outcome was need for PICU intervention; secondary outcomes included mortality and intubation.
A large quaternary free-standing children's hospital.
One-hundred two pediatric allogeneic hematopoietic cell transplant recipients.
None.
Of the 102 hematopoietic cell transplant patients included in the study, 29 were admitted to the PICU. The median peak Pediatric Early Warning Score was 11 (interquartile range, 8-13) in the PICU admission cohort, compared with 4 (interquartile range, 3-5) in the cohort without a PICU admission (p < 0.0001). Pediatric Early Warning Score greater than or equal to 8 had a sensitivity of 76% and a specificity of 90%. The area under the receiver operating characteristics curve was 0.83. There was a high negative predictive value at this Pediatric Early Warning Score of 90%. When Pediatric Early Warning Score greater than or equal to 8 and weight gain greater than or equal to 7% were compared together, the area under the receiver operating characteristic curve increased to 0.88.
In this study, a Pediatric Early Warning Score greater than or equal to 8 was associated with PICU admission, having a moderately high sensitivity and high specificity. This study adds to literature supporting Pediatric Early Warning Score monitoring for hematopoietic cell transplant patients. Combining weight gain with Pediatric Early Warning Score improved the discriminative ability of the model to predict the need for critical care, suggesting that incorporation of weight gain into Pediatric Early Warning Score may be beneficial for monitoring of hematopoietic cell transplant patients.
确定床边儿科早期预警评分系统在造血细胞移植人群中的有效性，并确定体重增加是否进一步加强了与 PIC U 入院需求的关联。
对 2009 年至 2016 年期间接受同种异体造血细胞移植的儿科患者进行回顾性队列研究。住院期间每天采集儿科早期预警评分和体重。使用逻辑回归确定最大儿科早期预警评分或儿科早期预警评分加体重增加与 PIC U 干预需求之间的关联。主要结局是 PIC U 干预需求；次要结局包括死亡率和插管。
一家大型的独立的儿童四级医院。
102 例接受同种异体造血细胞移植的儿科患者。
无。
在研究中纳入的 102 例造血细胞移植患者中，有 29 例患者被收治到 PIC U。在 PIC U 入院组中，中位峰值儿科早期预警评分（11 分[四分位数范围，8-13 分]）高于无 PIC U 入院组（4 分[四分位数范围，3-5 分]）（p<0.0001）。儿科早期预警评分≥8 分的敏感性为 76%，特异性为 90%。受试者工作特征曲线下面积为 0.83。在此儿科早期预警评分时，阴性预测值很高，为 90%。当比较儿科早期预警评分≥8 分和体重增加≥7%时，受试者工作特征曲线下面积增加到 0.88。
在这项研究中，儿科早期预警评分≥8 分与 PIC U 入院相关，具有中等高的敏感性和高特异性。这项研究增加了支持造血细胞移植患者进行儿科早期预警评分监测的文献证据。将体重增加与儿科早期预警评分相结合提高了模型预测需要重症监护的能力，这表明将体重增加纳入儿科早期预警评分可能对监测造血细胞移植患者有益。
