Arch Dis Child Fetal Neonatal Ed. 1998 May;78(3):F179-84. doi: 10.1136/fn.78.3.f179.
To assess whether different classifications of neonatal care or dependency scales are comparable when used in multicentre studies of cost effectiveness.
A survey of classifications was used in a nationally representative group of 57 units in 1990-1, with a retrospective study of 10 354 cot days using patient records from a 5% random sample of 1042 admissions. Local and national classifications were correlated with medical and nursing procedures recorded for up to 26 days after each admission.
Classifications varied substantially. Of the 57 units in our sample, 26 used one of two national classifications, sometimes modified; 17 used the Northern Neonatal Network dependency scale; and the other 14 did not record daily levels of care. In each classification, the highest level was having respiratory support by ventilation or continuous distending pressure through an endotracheal tube, nasal prongs, facemask or negative pressure device. This level of care was consistently comparable between classifications; lower levels were not.
Retrospective comparisons between units with different classifications can only reliably differentiate between days with and without respiratory support. There is a pressing need to develop and validate more appropriate scales for prospective multicentre studies. These should relate activity to costs and outcome.
评估在成本效益多中心研究中使用时，新生儿护理或依赖程度的不同分类是否具有可比性。
1990 - 1991年对全国具有代表性的57个单位进行了分类调查，并对1042例入院病例的5%随机样本的患者记录进行回顾性研究，涉及10354个婴儿床日。将地方和国家分类与每次入院后长达26天记录的医疗和护理程序相关联。
分类差异很大。在我们样本中的57个单位中，26个使用了两种国家分类中的一种，有时会进行修改；17个使用了北方新生儿网络依赖程度量表；另外14个没有记录每日护理水平。在每种分类中，最高级别是通过通气或通过气管内导管、鼻导管、面罩或负压装置进行持续扩张压力来提供呼吸支持。这种护理水平在不同分类之间始终具有可比性；较低级别则不然。
不同分类单位之间的回顾性比较只能可靠地区分有无呼吸支持的天数。迫切需要为前瞻性多中心研究开发和验证更合适的量表。这些量表应将活动与成本和结果联系起来。
