儿童死亡危险评分在院间转诊患儿中的应用  

The performance of pediatric risk of mortality in inter-hospital transport of critically ill pediatric patients

作　　者：卢秀兰[1] 仇君[1] 祝益民[2] 陈鹏[1] 刘潇[1] 刘萍萍[1] 左超[1] 唐亮[1] 肖政辉[1] 

机构地区：[1]湖南省儿童医院急救中心,长沙410007 [2]湖南省人民医院儿科医学中心,长沙410005

出　　处：《中国小儿急救医学》2014年第11期681-683,688,共4页Chinese Pediatric Emergency Medicine

基　　金：国家十二五科技支撑计划项目（2012BAI04B02）;湖南省卫生厅资助项目（C2013-032）

摘　　要：目的 通过前瞻性研究的方法,评估儿童死亡危险（pediatric risk of mortality,PRISM）评分对院间转诊重症患儿死亡风险的预测能力.方法 2012年8月1日至2013年5月31日转诊的412例重症患儿为研究对象,收集PRISM评分系统的相关生理参数及结局资料,通过受试者工作特征曲线下的面积来评估PRISM对死亡和存活的分辨力,Hosmer-Lemeshow拟合优度检验来评估预期病死率和实际病死率是否拟合.结果 本研究纳入的412例院间转诊患儿中,367例（89.08％）为新生儿和婴儿,疾病类型以呼吸系统疾病（172例）和混合性疾病（169例）为主.45例患儿在住院期间发生死亡,病死率为10.92％.PRISM评分对应的受试者工作特征曲线下面积是0.829（95％ CI0.768～0.890）.对PⅪSM评分进行Hosmer-Lemeshow拟合优度检验,计算出卡方值为8.75 （P =0.364）.结论 PRISM对院间转诊重症患儿的死亡风险评估具有较好的分辨力和拟合度.Objective To assess the performance of pediatric risk of mortality（PRISM） in predicting mortality probability in inter-hospital transport of critically ill pediatric patients by a perspective study.Methods Four hundred and twelve pediatric patients with inter-hospital transportations were recruited in the study from lth August 2012 to 31 th May 2013.The information on demographic characteristics,the reasons for inter-hospital transport,the category of disease and the severity of illness was collected.Information on age,sex,diagnosis,length of stay in PICU,the outcome and the variables required to calculate PRISM score were collected.The logistic regression model developed in the learning sample was evaluated in the test sample by calculating the area under the receiver operating characteristic plot（Az ROC）to assess discrimination between death and survival.Calibration across deciles of risk was evaluated using the Hosmer-Lemeshow goodness-of-fit x2 test.Results Among 412 inter-hospital transport of critically ill pediatric patients,the majority of patients （89.08％,367/412）were neonates and infants,and above two thirds of the children were suffering from respiratory diseases （172 cases）,and miscellaneous diseases （169 cases）.Forty-five （10.92％） inter-hospital transport of critically ill pediatric patients died at the time of hospitalization.The area under the receiver-operating characteristic curve was 0.829（95％ confidence intervals 0.768 ～ 0.890）for PRISM.The Hosmer-Lemeshow test gave a chisquare of 8.75 （P =0.364） for PRISM.Conclusion The PRISM score is demonstrated good discrimination and calibration in predicting death probability of inter-hospital transport of critically ill pediatric patients.

关 键 词：院间转诊 重症患儿 儿童死亡风险评分 

分 类 号：R473.72[医药卫生—护理学]