Zollo M B, Moskop J C, Kahn C E
Medical College of Wisconsin, Milwaukee, USA.
Am J Crit Care. 1996 Mar;5(2):147-51.
Outcome scores have been promoted as adjuncts to clinical decision making, especially when further care is thought to be futile. The Pediatric Risk of Mortality score is used to calculate the risk of mortality for patients admitted to pediatric intensive care units. In this article the Pediatric Risk of Mortality score in evaluated for its ability to contribute to individual patient care decisions in the context of clinical practice. Through analysis several features of the Pediatric Risk of Mortality score were identified that require discretion if the score is to be used in decisions involving individual patients. These features include variability and bias introduced in data collection and data presentation. Also, outcome scores do not allow for the incorporation of patient and family values into the decision process. Outcome scores can provide some adjunctive information to clinicians, but they should be used with caution when making patient care decisions. Use of Pediatric Risk of Mortality scores in clinical practice must be tempered with a knowledge of the limitations of the scores, individual patient variability, the conditions under which the scores have been validated and collected and, most importantly, an awareness that outcome scores do not take into account the caregiver and patient values that are inherent in any treatment decision.
结果评分已被推广作为临床决策的辅助手段，尤其是在认为进一步治疗无用时。儿科死亡风险评分用于计算入住儿科重症监护病房患者的死亡风险。本文评估了儿科死亡风险评分在临床实践背景下对个体患者护理决策的贡献能力。通过分析，确定了儿科死亡风险评分的几个特征，如果要将该评分用于涉及个体患者的决策，就需要谨慎考虑。这些特征包括数据收集和数据呈现中引入的变异性和偏差。此外，结果评分不允许将患者和家属的价值观纳入决策过程。结果评分可以为临床医生提供一些辅助信息，但在做出患者护理决策时应谨慎使用。在临床实践中使用儿科死亡风险评分时，必须了解该评分的局限性、个体患者的变异性、评分已被验证和收集的条件，最重要的是，要意识到结果评分没有考虑到任何治疗决策中固有的护理人员和患者价值观。
