Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Canada; McGill University, Montreal, Canada; Sherbrooke University, Sherbrooke, Canada.
Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Canada; McGill University, Montreal, Canada.
J Pediatr Surg. 2022 May;57(5):798-812. doi: 10.1016/j.jpedsurg.2021.12.036. Epub 2022 Jan 20.
With improved long-term survival rates, measuring the quality of surgical care has gradually shifted from clinical morbidity and mortality to patient-reported outcome measures (PROMs). Since the use of PROMs in pediatric surgery is still limited, we undertook a study to identify current PROMs, assess their characteristics, and identify gaps and areas for improvement.
A search was conducted in eight databases from their inception until May 2021 to identify PROMs that have been used in pediatric surgical patients. PRISMA standards were followed, and screening was completed by two independent reviewers. The quality of the included studies was appraised using the AXIS and the Mixed Methods Appraisal Tool.
Of 8282 studies screened, 101 articles met the inclusion criteria. Most of the studies (99%) were cross-sectional. We identified 85 different PROMs among the studies, 53 being disease-specific and the rest generic. The PedsQL™ was the most frequently used tool (42 studies). Almost half of the instruments (41 studies) were not validated, and 28% were developed ad hoc for each specific study. Significantly, all PROMs encountered were standardized (consisting of pre-determined domains), with no individualized tools currently in use. The overall quality of the included studies was good.
PROMs are increasingly used in pediatric surgery. Disease-specific PROMs predominate the field, yet validated and especially individualized PROMs are notably absent. Future efforts are needed to develop robust tools that reflect individual patient and family needs, preferences, and values, with the aim of furthering family-centered pediatric surgical care.
随着长期生存率的提高，手术护理质量的衡量标准已逐渐从临床发病率和死亡率转移到患者报告的结果测量（PROMs）。由于 PROM 在小儿外科中的应用仍然有限，我们进行了一项研究，以确定当前的 PROMs，评估其特征，并确定差距和改进领域。
从开始到 2021 年 5 月，在八个数据库中进行了搜索，以确定已在小儿外科患者中使用的 PROMs。遵循 PRISMA 标准，由两名独立审查员完成筛选。使用 AXIS 和混合方法评估工具评估纳入研究的质量。
在筛选出的 8282 项研究中，有 101 篇文章符合纳入标准。大多数研究（99%）为横断面研究。我们在研究中确定了 85 种不同的 PROMs，其中 53 种为疾病特异性，其余为通用型。PedsQL™是使用最频繁的工具（42 项研究）。近一半的工具（41 项研究）未经验证，28%是为每个特定研究专门开发的。值得注意的是，所有遇到的 PROMs 都是标准化的（由预先确定的领域组成），目前没有使用个性化工具。纳入研究的总体质量良好。
PROMs 在小儿外科中越来越多地使用。疾病特异性 PROMs 占据主导地位，但缺乏经过验证的特别是个体化的 PROMs。未来需要努力开发能够反映个体患者和家庭需求、偏好和价值观的强大工具，以进一步推动以家庭为中心的小儿外科护理。
