Heard C M, Fletcher J E, Papo M C
Department of Anesthesiology, Children's Hospital of Buffalo (SUNY), NY, USA.
Crit Care Med. 1998 Sep;26(9):1593-5. doi: 10.1097/00003246-199809000-00034.
To assess the clinical use of the Dynamic Objective Risk Assessment (DORA) severity of illness score in a site remote from its development.
Prospective chart review.
Tertiary referral pediatric intensive care unit (PICU).
One hundred sixty consecutive admissions involving 621 patient days.
None.
Pediatric Risk of Mortality (PRISM) scores were collected daily for all PICU patient days. Collection of data was performed by a physician not directly involved in the ordering of vital signs or laboratory data. The daily DORA score was calculated from the previous day's PRISM score and the admission PRISM score according to a previously described formula. The DORA score determines the patient's risk of mortality for the next 24 hrs. Also documented were the tests not ordered for each patient day. The sensitivity and specificity of the DORA score in our patient population were very similar to that previously reported using the previously described 1% cutoff for predicted mortality. We also noted that the tests ordered were related to the physician's perception of the patient's degree of sickness, and were themselves predictive of outcome.
An outcome scoring system created in one group of PICUs can be applied to patients in another PICU remote from where the scoring system was developed with similar ability to predict outcome.
在远离其开发地点的场所评估动态客观风险评估（DORA）疾病严重程度评分的临床应用。
前瞻性病历回顾。
三级转诊儿科重症监护病房（PICU）。
连续160例入院患者，共621个患者日。
无。
收集所有PICU患者日的每日儿科死亡风险（PRISM）评分。数据收集由一名未直接参与生命体征或实验室数据医嘱开具的医生进行。每日DORA评分根据前一天的PRISM评分和入院时的PRISM评分，按照先前描述的公式计算得出。DORA评分可确定患者未来24小时的死亡风险。还记录了每个患者日未开具的检查项目。在我们的患者群体中，DORA评分的敏感性和特异性与先前报告的使用先前描述的1%预测死亡率临界值时非常相似。我们还注意到，所开具的检查与医生对患者疾病程度的认知相关，并且这些检查本身也可预测预后。
在一组PICU中创建的预后评分系统可应用于另一组远离评分系统开发地点的PICU患者，且具有相似的预后预测能力。
