初始改良肺部指数评分可预测因哮喘入住儿科重症监护病房的患者的住院时间。
Initial Modified Pulmonary Index Score Predicts Hospital Length of Stay for Asthma Subjects Admitted to the Pediatric Intensive Care Unit.
机构信息
Respiratory Care Services, Duke University Medical Center, Durham, North Carolina.
Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina.
出版信息
Respir Care. 2020 Sep;65(9):1227-1232. doi: 10.4187/respcare.07396. Epub 2020 Feb 18.
BACKGROUND
Scoring systems are frequently used to assess the severity of pediatric asthma exacerbations. The modified pulmonary index score (MPIS) has been found to be highly correlated with length of stay (LOS) in the pediatric intensive care unit (PICU). We sought to evaluate the use of the MPIS to predict hospital LOS for patients admitted to our PICU.
METHODS
We retrospectively reviewed the medical records of pediatric asthma subjects aged 2-17 y admitted to our PICU between June 2014 and November 2017. We divided subjects a priori into 3 groups (low: MPIS 0-5; medium: MPIS 6-9; high: MPIS ≥ 10) based upon each subject's first MPIS documented in the PICU. Hospital LOS, PICU LOS, time on continuous albuterol, and increased respiratory support were compared between groups.
RESULTS
143 subjects were included. There were no differences for demographics, medical history, cause of exacerbations, or mean heart rate between groups. There were significant differences between groups for mean breathing frequency ( < .001), [Formula: see text] ( = .01), and [Formula: see text] ( < .004). There were significant differences between groups for route of admission ( = .02), high-flow nasal cannula use ( < .001), and use of a helium-oxygen mixture ( < .001). There were significant differences between groups for median hospital LOS (1.2 vs 2.3 vs 3.4 d, < .001), PICU LOS (0.39 vs 1.3 vs 2 d, < .001), and time on continuous albuterol (7.4 vs 20.6 vs 34.7 h, < .001). After adjusting for demographics and medical history, the incidence risk ratio for hospital LOS was 2.09 for PICU admission for an MPIS of 6-9 and 2.68 for an MPIS ≥ 10 when compared to an MPIS < 6.
CONCLUSIONS
The MPIS thresholds used in our pathway appropriately predicted LOS in our cohort of subjects with asthma admitted to the PICU. Higher MPIS was associated with increased hospital LOS, PICU LOS, and time on continuous albuterol.
背景
评分系统常用于评估儿科哮喘发作的严重程度。改良肺部指数评分（MPIS）与儿科重症监护病房（PICU）的住院时间（LOS）高度相关。我们试图评估 MPIS 用于预测入住 PICU 的患者的住院 LOS。
方法
我们回顾性分析了 2014 年 6 月至 2017 年 11 月期间入住我院 PICU 的 2-17 岁儿科哮喘患者的病历。我们根据每位患者在 PICU 记录的首次 MPIS 将患者预先分为 3 组（低：MPIS 0-5；中：MPIS 6-9；高：MPIS≥10）。比较组间住院 LOS、PICU LOS、持续沙丁胺醇时间和呼吸支持增加情况。
结果
共纳入 143 例患者。组间在人口统计学、病史、哮喘发作原因或平均心率方面无差异。组间平均呼吸频率（<0.001）、[Formula: see text]（=0.01）和[Formula: see text]（<0.004）有显著差异。组间入院途径（=0.02）、高流量鼻导管使用（<0.001）和氦氧混合使用（<0.001）有显著差异。组间中位住院 LOS（1.2 天、2.3 天、3.4 天，<0.001）、PICU LOS（0.39 天、1.3 天、2 天，<0.001）和持续沙丁胺醇时间（7.4 小时、20.6 小时、34.7 小时，<0.001）有显著差异。调整人口统计学和病史后，与 MPIS<6 相比，MPIS 为 6-9 时 PICU 入院的住院 LOS 风险比为 2.09，MPIS≥10 时为 2.68。
结论
我们通路中使用的 MPIS 阈值适当地预测了入住 PICU 的哮喘患者的 LOS。较高的 MPIS 与住院 LOS、PICU LOS 和持续沙丁胺醇时间增加有关。
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