Zoham Mojdeh Habibi, Mohammadpour Masoud, Yaghmaie Bahareh, Hadizadeh Amere, Eskandarizadeh Zahra, Beigi Effat H
Division of Pediatric Intensive Care, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Division of Pediatric Intensive Care, Children's Medical Center Hospital (Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran.
J Pediatr Intensive Care. 2021 Sep 10;12(4):312-318. doi: 10.1055/s-0041-1735297. eCollection 2023 Dec.
Despite the fact that unscheduled readmission to pediatric intensive care units (PICUs) has significant adverse consequences, there is a need for a predictive tool appropriate for use in the clinical setting. The aim of this study was to assess the ability of the modified Brighton pediatric early warning score (PEWS) to identify children at high risk for early unplanned readmission. In this retrospective cohort study, all patients aged 1 month to 18 years of age discharged from PICUs of two tertiary children's hospitals during the study interval were enrolled. Apart from demographic data, the association between PEWS and early readmission, defined as readmission within 48 hours of discharge, was analyzed by multivariable logistic regression. From 416 patients, 27 patients had early PICU readmission. Patients who experienced readmission were significantly younger than the controls. (≤12 months, 70.4 vs. 39.1%, = 0.001) Patients who were admitted from the emergency room (66.7 and 33.3% for emergency department (ED) and floor, respectively, = 0.012) had higher risk of early unplanned readmission. PEWS at discharge was significantly higher in patients who experienced readmission (3.07 vs. 0.8, < 0.001). A cut-off PEWS of 2, with sensitivity 85.2% and specificity 78.1%, determined the risk of unplanned readmission. Each 1-point increase in the PEWS at discharge significantly increases the risk of readmission (odds ratio [OR] = 3.58, 95% confidence interval [CI]: [2.42-5.31], < 0.001). PEWS can be utilized as a useful predictive tool regarding predicting unscheduled readmission in PICU. Further large-scale studies are needed to determine its benefits in clinical practice.
尽管小儿重症监护病房（PICU）非计划再入院会产生严重不良后果，但仍需要一种适用于临床环境的预测工具。本研究的目的是评估改良版布莱顿小儿早期预警评分（PEWS）识别早期非计划再入院高危儿童的能力。在这项回顾性队列研究中，纳入了研究期间从两家三级儿童医院的PICU出院的所有1个月至18岁的患者。除人口统计学数据外，通过多变量逻辑回归分析了PEWS与早期再入院（定义为出院后48小时内再入院）之间的关联。在416例患者中，有27例早期PICU再入院。经历再入院的患者明显比对照组年轻。（≤12个月，70.4%对39.1%，P = 0.001）从急诊室入院的患者（急诊科（ED）和病房分别为66.7%和33.3%，P = 0.012）早期非计划再入院风险更高。经历再入院的患者出院时的PEWS明显更高（3.07对0.8，P < 0.001）。PEWS临界值为2时，非计划再入院风险的敏感性为85.2%，特异性为78.1%。出院时PEWS每增加1分，再入院风险显著增加（优势比[OR]=3.58，95%置信区间[CI]：[2.42 - 5.31]，P < 0.001）。PEWS可作为预测PICU非计划再入院的有用预测工具。需要进一步的大规模研究来确定其在临床实践中的益处。
