Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital & Yuying Children's hospital of Wenzhou Medical University, Wenzhou, China.
Department of Anesthesiology, Maternal and Child Care Hospital of Anhui Province, Hefei, China.
BMJ Open. 2020 Mar 18;10(3):e036008. doi: 10.1136/bmjopen-2019-036008.
To integrate intrinsic surgical risk into the paediatric preoperative risk prediction score (PRPS) model to construct a more comprehensive risk scoring system (modified PRPS) and improve the prediction accuracy of postoperative intensive care unit (ICU) admission in paediatric patients.
This was a retrospective study conducted between 1 January and 30 December 2016. Data on age, American Society of Anaesthesiology physical status (ASA-PS), oxygen saturation, prematurity, non-fasted status, severity of surgery and immediate transfer to the ICU after surgery were collected. The modified PRPS was developed by logistic regression in the derivation cohort; it was tested and compared with the paediatric PRPS and ASA-PS by the Hosmer-Lemeshow test, the receiver operating characteristic (ROC) curve and Kappa analysis in the validation cohort.
Hospital-based study in China.
Paediatric patients (≤14 years) who underwent surgery under general anaesthesia were included, and those who needed reoperation due to surgical complications or stayed in the ICU preoperatively were excluded.
ICU admission rate, defined as any patients' direct disposition from the operating room to the ICU immediately after the surgery.
A total of 9261 paediatric patients were included in this study, with 418 patients admitted to the ICU. In the validation cohort, the modified PRPS model fit the test data well (deciles of risk goodness-of-fit χ=6.84, p=0.077). The area under the ROC curve of the modified PRPS, paediatric PRPS and ASA-PS were 0.963, 0.941 and 0.870, respectively (p<0.05), and the Kappa values were 0.620, 0.286 and 0.267. Analyses in the cohort indicated that the modified PRPS was superior to the paediatric PRPS and ASA-PS.
The modified PRPS integrating intrinsic surgical risk shows better prediction accuracy than the previous PRPS.
将内在手术风险纳入小儿术前风险预测评分（PRPS）模型中，构建一个更全面的风险评分系统（改良 PRPS），提高小儿术后入住重症监护病房（ICU）的预测准确性。
这是一项回顾性研究，于 2016 年 1 月 1 日至 12 月 30 日进行。收集了年龄、美国麻醉医师协会身体状况（ASA-PS）、氧饱和度、早产、未禁食状态、手术严重程度以及术后立即转入 ICU 等数据。通过逻辑回归在推导队列中开发了改良 PRPS；通过 Hosmer-Lemeshow 检验、接收者操作特征（ROC）曲线和 Kappa 分析在验证队列中对其进行了测试，并与小儿 PRPS 和 ASA-PS 进行了比较。
中国医院的基础研究。
纳入接受全身麻醉下手术的小儿患者（≤14 岁），排除因手术并发症需要再次手术或术前入住 ICU 的患者。
入住 ICU 率，定义为任何患者直接从手术室转入 ICU 术后立即。
本研究共纳入 9261 例小儿患者，其中 418 例患者入住 ICU。在验证队列中，改良 PRPS 模型拟合检验数据良好（风险等级的十等分拟合优度 χ=6.84，p=0.077）。改良 PRPS、小儿 PRPS 和 ASA-PS 的 ROC 曲线下面积分别为 0.963、0.941 和 0.870（p<0.05），Kappa 值分别为 0.620、0.286 和 0.267。队列分析表明，改良 PRPS 优于小儿 PRPS 和 ASA-PS。
纳入内在手术风险的改良 PRPS 显示出比以前的 PRPS 更好的预测准确性。
