George Washington University School of Medicine and Health Sciences, Washington, DC.
Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC.
Pediatr Crit Care Med. 2021 Jan 1;22(1):e19-e32. doi: 10.1097/PCC.0000000000002561.
To assess severity of illness trajectories described by the Criticality Index for survivors and deaths in five patient groups defined by the sequence of patient care in ICU and routine patient care locations.
The Criticality Index developed using a calibrated, deep neural network, measures severity of illness using physiology, therapies, and therapeutic intensity. Criticality Index values in sequential 6-hour time periods described severity trajectories.
Hospitals with pediatric inpatient and ICU care.
Pediatric patients never cared for in an ICU (n = 20,091), patients only cared for in the ICU (n = 2,096) and patients cared for in both ICU and non-ICU care locations (n = 17,023) from 2009 to 2016 Health Facts database (Cerner Corporation, Kansas City, MO).
None.
Criticality Index values were consistent with clinical experience. The median (25-75th percentile) ICU Criticality Index values (0.878 [0.696-0.966]) were more than 80-fold higher than the non-ICU values (0.010 [0.002-0.099]). Non-ICU Criticality Index values for patients transferred to the ICU were 40-fold higher than those never transferred to the ICU (0.164 vs 0.004). The median for ICU deaths was higher than ICU survivors (0.983 vs 0.875) (p < 0.001). The severity trajectories for the five groups met expectations based on clinical experience. Survivors had increasing Criticality Index values in non-ICU locations prior to ICU admission, decreasing Criticality Index values in the ICU, and decreasing Criticality Index values until hospital discharge. Deaths had higher Criticality Index values than survivors, steeper increases prior to the ICU, and worsening values in the ICU. Deaths had a variable course, especially those who died in non-ICU care locations, consistent with deaths associated with both active therapies and withdrawals/limitations of care.
Severity trajectories measured by the Criticality Index showed strong validity, reflecting the expected clinical course for five diverse patient groups.
评估Criticality Index 在五个患者组中的严重程度轨迹，这些患者组根据 ICU 中的患者护理顺序和常规患者护理地点定义。
使用校准的深度神经网络开发的 Criticality Index 通过生理学、治疗和治疗强度来衡量疾病的严重程度。Criticality Index 值在连续的 6 小时时间段内描述严重程度轨迹。
具有儿科住院和 ICU 护理的医院。
从未在 ICU 接受过护理的儿科患者（n = 20091）、仅在 ICU 接受过护理的患者（n = 2096）和在 ICU 和非 ICU 护理地点接受过护理的患者（n = 17023），来自 2009 年至 2016 年的 Health Facts 数据库（Cerner Corporation，堪萨斯城，密苏里州）。
无。
Criticality Index 值与临床经验一致。中位数（25-75 百分位）ICU Criticality Index 值（0.878 [0.696-0.966]）高于非 ICU 值 80 多倍（0.010 [0.002-0.099]）。转入 ICU 的非 ICU Criticality Index 值是非从未转入 ICU 的患者的 40 倍（0.164 比 0.004）。ICU 死亡患者的中位数高于 ICU 幸存者（0.983 比 0.875）（p < 0.001）。基于临床经验，五个组的严重程度轨迹符合预期。幸存者在 ICU 入院前非 ICU 位置的 Criticality Index 值逐渐升高，在 ICU 中的 Criticality Index 值逐渐降低，直至出院。死亡患者的 Criticality Index 值高于幸存者，在 ICU 之前急剧增加，在 ICU 中恶化。死亡患者的病程多变，尤其是那些在非 ICU 护理地点死亡的患者，这与主动治疗和停止/限制治疗相关的死亡一致。
Criticality Index 测量的严重程度轨迹具有很强的有效性，反映了五个不同患者组的预期临床过程。
