Duke-NUS Medical School, Singapore.
Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Pediatr Crit Care Med. 2020 Nov;21(11):e972-e980. doi: 10.1097/PCC.0000000000002417.
To assess the ability of two illness severity scores, Pediatric Logistic Organ Dysfunction Score 2 and Pediatric Index of Mortality 3, in predicting PICU-acquired morbidity.
Retrospective chart review conducted from April 2015 to March 2016.
Single-center study in a multidisciplinary PICU in a tertiary pediatric hospital in Singapore.
The study included all index admissions of patients 0-18 years old to the PICU during the study period.
None.
Three outcomes were assessed at hospital discharge: mortality, survival with new morbidity defined as an increase in the Functional Status Scale score of greater than or equal to 3 points from baseline, and survival without morbidity. Of 577 consecutive admissions, 95 were excluded: 82 readmissions, 10 patients greater than or equal to 18 years old, two patients with missing baseline data, and one transferred to another PICU. Of 482 patients, there were 37 hospital deaths (7.7%) and 39 (8.1%) with acquired new morbidity. Median admission Pediatric Logistic Organ Dysfunction Score 2 and Pediatric Index of Mortality 3 scores differed among the three outcome groups. In addition, differences were found in emergency admission and neurologic diagnosis rates, PICU mechanical ventilation usage rates, and PICU length of stay. The highest proportion of neurologic diagnoses was observed in the new morbidity group. The final model simultaneously predicted risks of mortality, survival with new morbidity and survival without morbidity using admission Pediatric Logistic Organ Dysfunction Score 2 score, admission type, neurologic diagnosis, and preexisting chronic disease. Pediatric Logistic Organ Dysfunction Score 2 was superior to Pediatric Index of Mortality 3 in predicting risks of mortality and new morbidity, as indicated by volume under surface values of 0.483 and 0.362, respectively.
Risk of mortality, survival with new morbidity, and survival without morbidity can be predicted simultaneously using admission Pediatric Logistic Organ Dysfunction Score 2, admission type, admission diagnosis, and preexisting chronic disease. Future independent studies will be required to validate the proposed model before clinical implementation.
评估两种疾病严重程度评分，儿科逻辑器官功能障碍评分 2 分和儿科死亡率 3 分，在预测 ICU 获得性发病率中的能力。
2015 年 4 月至 2016 年 3 月进行回顾性图表审查。
在新加坡一家三级儿科医院的多学科儿科 ICU 进行的单中心研究。
该研究包括研究期间 ICU 所有指数入院的 0-18 岁患者。
无。
在出院时评估了三种结果：死亡率、新发病率的存活，定义为从基线增加大于或等于 3 分的功能状态评分、无发病率的存活。在 577 例连续入院患者中，有 95 例被排除在外：82 例再入院，10 例患者年龄大于或等于 18 岁，2 例患者基线数据缺失，1 例转入另一家 ICU。在 482 例患者中，有 37 例院内死亡（7.7%）和 39 例（8.1%）获得新发病率。三种结果组之间的中位数入院儿科逻辑器官功能障碍评分 2 分和儿科死亡率 3 分不同。此外，在急诊入院和神经诊断率、ICU 机械通气使用率和 ICU 住院时间方面也存在差异。新发病率组观察到的神经诊断比例最高。最终模型使用入院儿科逻辑器官功能障碍评分 2 分、入院类型、神经诊断和既往慢性疾病同时预测死亡率、新发病率存活和无发病率存活的风险。儿科逻辑器官功能障碍评分 2 分在预测死亡率和新发病率风险方面优于儿科死亡率 3 分，分别为 0.483 和 0.362 的面积下值。
可以使用入院儿科逻辑器官功能障碍评分 2 分、入院类型、入院诊断和既往慢性疾病同时预测死亡率、新发病率存活和无发病率存活的风险。在临床实施之前，需要进行未来的独立研究来验证所提出的模型。
