Data Santorino, Mukama Martin, McMillan Douglas, Singhal Nalini, Bajunirwe Francis
Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda.
Consortium for Affordable Medical Technologies in Uganda, Mbarara, Uganda.
BMC Pediatr. 2020 Aug 27;20(1):406. doi: 10.1186/s12887-020-02307-2.
Neonatal mortality is high in developing countries. Lack of adequate training and insufficient management skills for sick newborn care contribute to these deaths. We developed a phone application dubbed Protecting Infants Remotely by Short Message Service (PRISMS). The PRISMS application uses routine clinical assessments with algorithms to provide newborn clinical management suggestions. We measured the feasibility, acceptability and efficacy of PRISMS by comparing its clinical case management suggestions with those of experienced pediatricians as the gold standard.
Twelve different newborn case scenarios developed by pediatrics residents, based on real cases they had seen, were managed by pediatricians and PRISMS® Each pediatrician was randomly assigned six of twelve cases. Pediatricians developed clinical case management plans for all assigned cases and then obtained PRISMS suggested clinical case managements. We calculated percent agreement and kappa (k) statistics to test the null hypothesis that pediatrician and PRISMS management plans were independent.
We found high level of agreement between pediatricians and PRISMS for components of newborn care including: 10% dextrose (Agreement = 73.8%), normal saline (Agreement = 73.8%), anticonvulsants (Agreement = 100%), blood transfusion (Agreement =81%), phototherapy (Agreement = 90.5%), and supplemental oxygen (agreement = 69.1%). However, we found poor agreement with potential investigations such as complete blood count, blood culture and lumbar puncture. PRISMS had a user satisfaction score of 3.8 out of 5 (range 1 = strongly disagree, 5 = strongly agree) and an average PRISMS user experience score of 4.1 out of 5 (range 1 = very bad, 5 = very good).
Management plans for newborn care from PRISMS showed good agreement with management plans from experienced Pediatricians. We acknowledge that the level of agreement was low in some aspects of newborn care.
发展中国家新生儿死亡率很高。缺乏对患病新生儿护理的充分培训和管理技能不足导致了这些死亡。我们开发了一款名为“通过短信服务远程保护婴儿”（PRISMS）的手机应用程序。PRISMS应用程序使用常规临床评估和算法来提供新生儿临床管理建议。我们通过将其临床病例管理建议与经验丰富的儿科医生的建议作为金标准进行比较，来衡量PRISMS的可行性、可接受性和有效性。
由儿科住院医师根据他们见过的实际病例编写的12种不同的新生儿病例场景，由儿科医生和PRISMS进行管理。每位儿科医生被随机分配12个病例中的6个。儿科医生为所有分配的病例制定临床病例管理计划，然后获取PRISMS建议的临床病例管理方案。我们计算了一致性百分比和kappa（k）统计量，以检验儿科医生和PRISMS管理计划相互独立的零假设。
我们发现儿科医生和PRISMS在新生儿护理的各个方面达成了高度一致，包括：10%葡萄糖（一致性=73.8%）、生理盐水（一致性=73.8%）、抗惊厥药（一致性=100%）、输血（一致性=81%）、光疗（一致性=90.5%）和补充氧气（一致性=69.1%）。然而，我们发现对于诸如全血细胞计数、血培养和腰椎穿刺等潜在检查的一致性较差。PRISMS的用户满意度得分为3.8分（满分5分，范围为1=强烈不同意，5=强烈同意），PRISMS用户体验平均得分为4.1分（满分5分，范围为1=非常差，5=非常好）。
PRISMS的新生儿护理管理计划与经验丰富的儿科医生的管理计划显示出良好的一致性。我们承认在新生儿护理的某些方面一致性水平较低。
