Department of Paediatric Intensive Care Medicine, Children's Health Queensland, South Brisbane, QLD, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, VIC, Australia.
Pediatr Crit Care Med. 2020 Jun;21(6):520-525. doi: 10.1097/PCC.0000000000002233.
To investigate if the performance of Pediatric Index of Mortality 3 is improved by including imputed values for the PaO2/FIO2 ratio where measurements of PaO2 or FIO2 are missing.
A prospective observational study.
A bi-national pediatric intensive care registry.
The records of 37,983 admissions of children less than 16 years old admitted to 19 ICUs.
None.
Seven published equations describing an association between PaO2/FIO2 and oxygen saturation measured by pulse oximetry (SpO2)/FIO2 were used to derive an alternative variable d100 × FIO2/PaO2 for the Pediatric Index of Mortality 3 variable 100 × FIO2/PaO2. Six equations exclude SpO2/FIO2 values if SpO2 is greater than 96-98%. 100 × FIO2/PaO2 was missing in 72% of patient records primarily due to missing PaO2, d100 × FIO2/PaO2 was missing in 71% of patient records if values of SpO2greater than 97% were excluded or in 17% of patient records if all measurements of SpO2 were included. Univariable analysis supported the inclusion of SpO2 values greater than 97%. Compared to the standard Pediatric Index of Mortality 3 model, two alternative models imputing 100 × FIO2/PaO2 from d100 × FIO2/PaO2 only if 100 × FIO2/PaO2 was missing, or using d100 × FIO2/PaO2 values exclusively, resulted in a small but statistically significant improvements in discrimination of Pediatric Index of Mortality 3 (area under the receiver operator curve 0.9068 [0. 8965-0. 9171]; 0.9083 [0.8981-0.9184]; 0.9087 [0.8987-0.9188], respectively).
Imputation of the PaO2/FIO2 ratio in cases where arterial sampling was not performed resulted in a large reduction in the rate of missing data if all values of SpO2 were included. The imputation technique improved the discrimination of Pediatric Index of Mortality 3; however, the magnitude of the increment in overall model performance was small. A possible benefit of the approach is reducing the potential for bias resulting from variation in practice for invasive monitoring of oxygenation.
研究在 PaO2/FIO2 比值缺失时，通过纳入对 PaO2 或 FIO2 测量值的推断值，是否可以改善儿科死亡率 3 （Pediatric Index of Mortality 3，PiOCTM3）的性能。
前瞻性观察性研究。
一个双国家儿科重症监护登记处。
纳入了 19 个 ICU 中年龄小于 16 岁的 37983 例患儿的住院记录。
无。
使用 7 种已发表的方程来描述 PaO2/FIO2 与通过脉搏血氧仪（SpO2）/FIO2 测量的氧饱和度之间的关系，这些方程被用来推导 PiOCTM3 变量 100 × FIO2/PaO2 的替代变量 d100 × FIO2/PaO2。6 个方程排除了 SpO2/FIO2 值，如果 SpO2 大于 96-98%。如果排除 SpO2 大于 97%的数值，100 × FIO2/PaO2 的缺失率为 72%，如果包括所有 SpO2 测量值，100 × FIO2/PaO2 的缺失率为 17%，患者记录中主要是因为 PaO2 缺失，71%的患者记录中 d100 × FIO2/PaO2 的缺失率，如果排除 SpO2 大于 97%的数值。单变量分析支持纳入 SpO2 值大于 97%。与标准的 PiOCTM3 模型相比，两种替代模型仅在 PiOCTM3 缺失 100 × FIO2/PaO2 时从 d100 × FIO2/PaO2 推断 100 × FIO2/PaO2，或者仅使用 d100 × FIO2/PaO2 值，对 PiOCTM3 的区分度略有提高（接受者操作特征曲线下面积分别为 0.9068[0.8965-0.9171]；0.9083[0.8981-0.9184]；0.9087[0.8987-0.9188]）。
如果未进行动脉采样，则对 PaO2/FIO2 比值进行推断，如果纳入所有 SpO2 值，可显著降低缺失数据的比率。该推断技术提高了 PiOCTM3 的判别能力；然而，整体模型性能的增量幅度较小。该方法的一个潜在优势是减少因对氧合的侵入性监测的实践差异而导致的潜在偏差。
