Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany.
Department of Paediatric Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany.
Cardiol Young. 2024 Mar;34(3):637-642. doi: 10.1017/S1047951123003189. Epub 2023 Sep 11.
Paediatric early warning score systems are used for early detection of clinical deterioration of patients in paediatric wards. Several paediatric early warning scores have been developed, but most of them are not suitable for children with cyanotic CHD who are adapted to lower arterial oxygen saturation.
The present study compared the original paediatric early warning system of the Royal College of Physicians of Ireland with a modification for children with cyanotic CHD.
Retrospective single-centre study in a paediatric cardiology intermediate care unit at a German university hospital.
The distribution of recorded values showed a significant shift towards higher score values in patients with cyanotic CHD (p < 0.001) using the original score, but not with the modification. An analysis of sensitivity and specificity for the factor "requirement of action" showed an area under the receiver operating characteristic for non-cyanotic patients of 0.908 (95% CI 0.862-0.954). For patients with cyanotic CHD, using the original score, the area under the receiver operating characteristic was reduced to 0.731 (95% CI 0.637-0.824, p = 0.001) compared to 0.862 (95% CI 0.809-0.915, p = 0.207), when the modified score was used. Using the critical threshold of scores ≥ 4 in patients with cyanotic CHD, sensitivity and specificity for the modified score was higher than for the original (sensitivity 78.8 versus 72.7%, specificity 78.2 versus 58.4%).
The modified score is a uniform scoring system for identifying clinical deterioration, which can be used in children with and without cyanotic CHD.
儿科预警评分系统用于早期发现儿科病房患者的临床恶化。已经开发了几种儿科预警评分，但大多数不适合适应较低动脉血氧饱和度的发绀性 CHD 患儿。
本研究比较了爱尔兰皇家内科医师学院的原始儿科预警系统与针对发绀性 CHD 儿童的改良版。
德国大学医院儿科心脏病学中级护理病房的回顾性单中心研究。
记录值的分布显示，使用原始评分，发绀性 CHD 患者的评分值明显向高分值偏移（p<0.001），但使用改良版则不然。对“需要采取行动”因素的敏感性和特异性分析表明，非发绀患者的接受者操作特征曲线下面积为 0.908（95%CI 0.862-0.954）。对于发绀性 CHD 患者，使用原始评分时，接受者操作特征曲线下面积从 0.862（95%CI 0.809-0.915，p=0.207）降至 0.731（95%CI 0.637-0.824，p=0.001），而使用改良评分时则为 0.731（95%CI 0.637-0.824，p=0.001）。在发绀性 CHD 患者中，使用临界评分≥4 时，改良评分的敏感性和特异性均高于原始评分（敏感性 78.8%比 72.7%，特异性 78.2%比 58.4%）。
改良评分是一种用于识别临床恶化的统一评分系统，可用于发绀性和非发绀性 CHD 患儿。
