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儿科重症监护中的患者特征与资源利用

Patient characteristics and resource utilisation in paediatric intensive care.

作者信息

Gemke R J, Bonsel G J, McDonnell J, van Vught A J

机构信息

Department of Paediatric Intensive Care, Wilhelmina Children's Hospital, Utrecht, The Netherlands.

出版信息

Arch Dis Child. 1994 Oct;71(4):291-6. doi: 10.1136/adc.71.4.291.

Abstract

To determine the relation between basic clinical characteristics and resource utilisation in paediatric intensive care, an open prospective study was performed. Resource utilisation was expressed using the therapeutic intervention score system (TISS) and length of stay (LOS), from which total resource utilisation per admission (TISSTOT) and average daily resource utilisation (TISSMEAN = TISSTOT/LOS) were obtained. Overall 593 admissions, totalling 3130 days, were included. Mortality was 8.4% and non-survivors accounted for 14.1% of overall resource utilisation. In non-survivors, TISSTOT and TISSMEAN were higher, whereas LOS was not different from survivors'. Severity of illness, surgical status, significant chronic comorbidity, emergency admission, and transfer status constituted the major predictive determinants of TISSTOT (r2 = 0.19) and TISSMEAN (r2 = 0.45) in multiple regression analysis. High resource utilisation in high risk patients was probably warranted, as effectiveness of prolonged intensive treatment was demonstrated. It is concluded that TISSTOT and TISSMEAN are appropriate, non-monetary measures of resource utilisation, a considerable proportion of which are determined by a concise set of basic clinical characteristics.

摘要

为了确定儿科重症监护中基本临床特征与资源利用之间的关系,开展了一项开放性前瞻性研究。资源利用情况通过治疗干预评分系统(TISS)和住院时间(LOS)来表示,据此得出每次入院的总资源利用情况(TISSTOT)和日均资源利用情况(TISSMEAN = TISSTOT/LOS)。总共纳入了593例次入院病例,共计3130天。死亡率为8.4%,非幸存者占总资源利用的14.1%。在非幸存者中,TISSTOT和TISSMEAN较高,而住院时间与幸存者并无差异。在多因素回归分析中,疾病严重程度、手术状态、显著的慢性合并症、急诊入院和转科状态是TISSTOT(r2 = 0.19)和TISSMEAN(r2 = 0.45)的主要预测决定因素。鉴于延长强化治疗的有效性得到证实,高风险患者的高资源利用可能是合理的。结论是,TISSTOT和TISSMEAN是衡量资源利用情况的合适的非货币指标,其中相当一部分由一组简明的基本临床特征所决定。

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本文引用的文献

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Assessment of pediatric intensive care--application of the Therapeutic Intervention Scoring System.
Crit Care Med. 1982 Aug;10(8):497-500. doi: 10.1097/00003246-198208000-00002.
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Therapeutic Intervention Scoring System: update 1983.治疗干预评分系统:1983年更新版
Crit Care Med. 1983 Jan;11(1):1-3. doi: 10.1097/00003246-198301000-00001.
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Inappropriate use of intensive care.重症监护的不当使用。
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