儿科重症监护病房的死亡率存在性别差异吗？：一项系统综述。
Is there a sex difference in mortality rates in paediatric intensive care units?: a systematic review.
作者信息
Almossawi Ofran, Friend Amanda, Palla Luigi, Feltbower Richard G, Sardo-Infiri Sofia, O'Brien Scott, Harron Katie, Nadel Simon, Saunders Paul, De Stavola Bianca
机构信息
Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
Institute of Child Health, University College London, London, United Kingdom.
出版信息
Front Pediatr. 2023 Oct 9;11:1225684. doi: 10.3389/fped.2023.1225684. eCollection 2023.
INTRODUCTION
Mortality rates in infancy and childhood are lower in females than males. However, for children admitted to Paediatric Intensive Care Units (PICU), mortality has been reported to be lower in males, although males have higher admission rates. This female mortality excess for the subgroup of children admitted in intensive care is not well understood. To address this, we carried out a systematic literature review to summarise the available evidence. Our review studies the differences in mortality between males and females aged 0 to <18 years, while in a PICU, to examine whether there was a clear difference (in either direction) in PICU mortality between the two sexes, and, if present, to describe the magnitude and direction of this difference.
METHODS
Any studies that directly or indirectly reported the rates of mortality in children admitted to intensive care by sex were eligible for inclusion. The search strings were based on terms related to the population (those admitted into a paediatric intensive care unit), the exposure (sex), and the outcome (mortality). We used the search databases MEDLINE, Embase, and Web of Science as these cover relevant clinical publications. We assessed the reliability of included studies using a modified version of the risk of bias in observational studies of exposures (ROBINS-E) tool. We considered estimating a pooled effect if there were at least three studies with similar populations, periods of follow-up while in PICU, and adjustment variables.
RESULTS
We identified 124 studies of which 114 reported counts of deaths by males and females which gave a population of 278,274 children for analysis, involving 121,800 (44%) females and 156,474 males (56%). The number of deaths and mortality rate for females were 5,614 (4.61%), and for males 6,828 (4.36%). In the pooled analysis, the odds ratio of female to male mortality was 1.06 [1.01 to 1.11] for the fixed effect model, and 1.10 [1.00 to 1.21] for the random effects model.
DISCUSSION
Overall, males have a higher admission rate to PCU, and potentially lower overall mortality in PICU than females.
SYSTEMATIC REVIEW REGISTRATION
www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=203009, identifier (CRD42020203009).
引言
婴儿期和儿童期的死亡率女性低于男性。然而，据报道，入住儿科重症监护病房（PICU）的儿童中，男性死亡率较低，尽管男性的入院率较高。对于入住重症监护病房的儿童亚组中女性死亡率较高这一现象，目前尚未完全了解。为了解决这一问题，我们进行了一项系统的文献综述，以总结现有证据。我们的综述研究了0至<18岁男性和女性在PICU中的死亡率差异，以检查两性在PICU死亡率上是否存在明显差异（无论方向），如果存在差异，则描述这种差异的大小和方向。
方法
任何直接或间接报告按性别划分的重症监护病房入院儿童死亡率的研究均符合纳入标准。检索词基于与人群（入住儿科重症监护病房的人群）、暴露因素（性别）和结局（死亡率）相关的术语。我们使用MEDLINE、Embase和Web of Science等检索数据库，因为这些数据库涵盖了相关的临床出版物。我们使用暴露因素观察性研究的偏倚风险（ROBINS-E）工具的修改版评估纳入研究的可靠性。如果至少有三项研究具有相似的人群、在PICU的随访期和调整变量，我们考虑估计合并效应。
结果
我们识别出124项研究，其中114项报告了男性和女性的死亡人数，共有278,274名儿童纳入分析，其中女性121,800名（44%），男性156,474名（56%）。女性的死亡人数和死亡率分别为5,614名（4.61%）和男性6,828名（4.36%）。在合并分析中，固定效应模型下女性与男性死亡率的比值比为1.06[1.01至1.11]，随机效应模型下为1.10[1.00至1.21]。
讨论
总体而言，男性入住PCU的比率较高，且在PICU中的总体死亡率可能低于女性。
系统综述注册
www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=203009，标识符（CRD42020203009）。
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