Chamberlain J M, Patel K M, Ruttimann U E, Pollack M M
George Washington University School of Medicine and Health Sciences, Children's National Medical Center, Washington, DC 20010, USA.
Ann Emerg Med. 1998 Aug;32(2):161-9. doi: 10.1016/s0196-0644(98)70132-5.
The development and validation of a pediatric emergency department severity of illness assessment method, using hospital admission as the primary outcome.
A random sample of 25% of ED charts from 4 consecutive months in a university-affiliated pediatric hospital was reviewed, after exclusion of children with minor injuries and children triaged to the nonurgent clinic. Sampled data included components of the medical history, physical findings, physiologic variables, diagnoses, and ED therapies. Univariate and multivariate logistic regression analyses, with bootstrapping validation, were performed to develop a bias-corrected model estimating the probability of hospital admission.
Of the 2,683 ED patients whose records were reviewed, 643 (24%) were admitted to the hospital. The final model, which yielded a Pediatric Risk of Admission (PRISA) score, included the following: 3 components of the medical history, 3 chronic disease factors, 9 physiologic variables, 2 therapies, and 4 interaction terms. Overall, the number of hospital admissions was well predicted in both the 80% development and 20% validation samples. In the former, 514 admissions were predicted and 514 were observed; in the latter, 126.9 admissions were predicted and 129 were observed. The Hosmer-Lemeshow goodness-of-fit test demonstrated good agreement between observed and expected admissions in consecutive deciles of admission probability; total chi2 was 10.49 (P=.233) for the development sample and 11.85 (P=.222) for the validation sample. The areas under the receiver operating characteristic curves (+/-SE) were .86+/-.011 and .825+/-.024, respectively. As the risk of hospital admission increased, the proportions of patients using unique hospital-based resources and using ICU resources increased, and the proportion of patients dying increased.
The probability of admission to the hospital can reliably be estimated from data available during the pediatric ED stay. Applications for this method include studies of quality and efficiency of care and measurements of severity of illness.
开发并验证一种以住院作为主要结局的儿科急诊科疾病严重程度评估方法。
在一所大学附属医院连续4个月的急诊病历中随机抽取25%的样本进行回顾，排除轻伤儿童和被分诊到非紧急门诊的儿童。抽样数据包括病史、体格检查结果、生理变量、诊断和急诊治疗等方面。进行单因素和多因素逻辑回归分析，并采用自助法验证，以建立一个偏差校正模型来估计住院概率。
在2683例接受病历回顾的急诊患者中，643例（24%）住院。最终模型得出了儿科住院风险（PRISA）评分，包括以下内容：3个病史组成部分、3个慢性病因素、9个生理变量、2种治疗方法和4个交互项。总体而言，在80%的开发样本和20%的验证样本中，住院人数均得到了较好的预测。在开发样本中，预测住院514例，实际观察到514例；在验证样本中，预测住院126.9例，实际观察到129例。Hosmer-Lemeshow拟合优度检验显示，在连续十分位数的住院概率中，观察到的和预期的住院情况之间具有良好的一致性；开发样本的总卡方值为10.49（P = 0.233），验证样本的总卡方值为11.85（P = 0.222）。受试者工作特征曲线下的面积（±标准误）分别为0.86±0.011和0.825±0.024。随着住院风险的增加，使用独特的医院资源和使用重症监护病房资源的患者比例增加，死亡患者比例也增加。
根据儿科急诊就诊期间可获得的数据能够可靠地估计住院概率。该方法的应用包括护理质量和效率研究以及疾病严重程度测量。
