van Veen A, Karstens A, van der Hoek A C, Tibboel D, Hählen K, van der Voort E
Department of Pediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands.
Intensive Care Med. 1996 Mar;22(3):237-41. doi: 10.1007/BF01712243.
To evaluate the predicted mortality rate of oncologic patients in the PICU using the PRISM score and factors that might influence short-term outcomes.
Retrospective study.
Pediatric ICU in a university hospital.
The medical charts of all oncologic patients admitted to the PICU during the period from January 1983 to December 1992 were reviewed.
Over a period of 10 years, 51 oncologic patients were admitted on 57 occasions to the PICU. The mortality was 32%. This is significantly higher than the overall mortality in the PICU (8%). Comparison of observed and predicted mortality, derived from the PRISM score, using chi square goodness-of-fit tests showed a significantly higher observed mortality (x2(5) = 20.1, P < 0.01). Patients admitted for circulatory failure had the highest mortality (47%), followed by those with respiratory failure due to tachypnea/cyanosis (36%), central nervous system deterioration (27%), respiratory failure due to airway obstruction (25%), and metabolic disorders (20%). Of the 31 patients who needed mechanical ventilation, 17 died (55%), and when they needed inotropic support as well, the mortality increased to 69%. The mortality rose to 100% when the patient was admitted with a septic shock, necessitating mechanical ventilation and inotropic support. The median PRISM score was 5 in the survivor group and 18.5 in the non-survivor group; this difference was found to be significant using the Wilcoxon test (P = 0.01). However, some patients with high scores were found in the survivor group, as well as some with low scores in the non-survivor group.
The decision to treat oncologic patients in a PICU remains difficult and has to be considered on an individual basis. However, oncologic patients do benefit from admission to the PICU. The PRISM score is not suitable for oncologic patients in the PICU, because it underestimates the observed mortality. Other factors like neutropenia, septic shock, the need for mechanical ventilation, and inotropic support should be taken into consideration.
使用PRISM评分评估儿科重症监护病房（PICU）中肿瘤患者的预测死亡率以及可能影响短期预后的因素。
回顾性研究。
一所大学医院的儿科重症监护病房。
回顾了1983年1月至1992年12月期间入住PICU的所有肿瘤患者的病历。
在10年期间，51例肿瘤患者57次入住PICU。死亡率为32%。这显著高于PICU的总体死亡率（8%）。使用卡方拟合优度检验比较PRISM评分得出的观察到的死亡率和预测死亡率，结果显示观察到的死亡率显著更高（χ²(5)=20.1，P<0.01）。因循环衰竭入院的患者死亡率最高（47%），其次是因呼吸急促/发绀导致呼吸衰竭的患者（36%）、中枢神经系统恶化的患者（27%）、因气道阻塞导致呼吸衰竭的患者（25%）以及代谢紊乱的患者（20%）。在31例需要机械通气的患者中，17例死亡（55%），当他们还需要血管活性药物支持时，死亡率增至69%。当患者因感染性休克入院，需要机械通气和血管活性药物支持时，死亡率升至100%。存活组的PRISM评分中位数为5，非存活组为18.5；使用Wilcoxon检验发现这种差异具有统计学意义（P=0.01）。然而，在存活组中发现了一些高分患者，在非存活组中也发现了一些低分患者。
决定是否在PICU治疗肿瘤患者仍然很困难，必须根据个体情况进行考虑。然而，肿瘤患者确实从入住PICU中获益。PRISM评分不适用于PICU中的肿瘤患者，因为它低估了观察到的死亡率。应考虑其他因素，如中性粒细胞减少、感染性休克、是否需要机械通气以及血管活性药物支持等。
