儿童死亡风险评分和小儿死亡指数评分在危重患儿病情评价中的效能  

Performance of pediatric risk of mortality and pediatric index of mortality in evaluation of the patients＆#39; condition

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[3] 唐亮[3] 肖政辉[1] 

机构地区：[1]湖南省儿童医院急救中心,长沙410007 [2]湖南省人民医院儿童医学中心,长沙410007 [3]南华大学儿科学院

出　　处：《中华儿科杂志》2015年第5期370-374,共5页Chinese Journal of Pediatrics

基　　金：国家“十二五”科技支撑计划（2012BA104802）;重症患儿院间转运急救的风险评估（C2013-032）

摘　　要：目的 分析儿童死亡风险评分（PRISM）和小儿死亡指数评分2（PIM2）对危重患儿死亡风险的预测能力.方法 收集PRISM和PIM2两个预测模型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（AUC）来评估PRISM和PIM2对死亡和存活的分辨力,Hosmer-Lemeshow 拟合优度检验来评估预期死亡率和实际死亡率是否拟合.结果 本研究纳入2012年8月1日至2013年5月31日从外院转入湖南省儿童医院急救中心的412例危重患儿为研究对象,以呼吸系统疾病（172例,41.7％）和多系统混合性疾病（169例,41.0％）为主.住院期间死亡患儿45例,病死率10.9％.PRISM预测死亡人数为45.01例,预测死亡率10.9％,PIM2预测死亡人数为44.99例,预测死亡率为10.9％.PRISM和PIM2的标准化死亡率（SMR）分别为1.000 （0.710～1.290）和1.000（0.710～1.290）.对PRISM和PIM2进行Hosmer-Lemeshow拟合优度检验,PRISM x2值为8.75（P=0.364）,与实际死亡率拟合性好;PIM2 x2值为22.75（P ＜0.05）,与实际死亡率拟合性欠佳.PRISM和PIM2对应的AUC分别为0.829 （0.768～0.890）和0.758 （0.667 ～0.849）.结论 PRISM的拟合性可,而PIM2的拟合性欠佳,但PRISM和PIM2均能较好地对危重患儿是否可能发生死亡进行预测,可以应用于重症监护病房,对危重患儿病情严重性进行评估.Objective To assess the performance of pediatric risk of mortality （PRISM）,pediatric index of mortality 2 （PIM2） in predicting mortality in critically ill pediatric patients via a prospective study.Method The outcome and the variables required to calculate PRISM and PIM2 were collected.The efficiency of PRISM and PIM2 in differentiation between death and survival by calculating the area under the receiver operating characteristic curve （ROC）.Calibration across deciles of risk was evaluated using the Hosmer-Lemeshow goodness-of-fit x2 test.Result A total of 412 critically ill pediatric patients transferred to Hunan Children＇s Hospital during August 1,2012 and May 31,2013 were enrolled in the study,and more than two-thirds of the children were suffering from respiratory and miscellaneous diseases; 45 （10.9%） inter-hospital transport of critically ill pediatric patients died at the time of hospitalization.The expected number of deaths were 45.01 by PRISM,and the expected number of deaths were 44.99 by PIM2.The expected mortality rate was 10.9% for PRISM or PIM2.The standardized mortality rate was 1.000（0.710-1.290）for PRISM and 1.000 （0.710-1.290）for PIM2.The Hosmer-Lemeshow test gave a chi-square of 8.75 （P =0.364） for PRISM and 22.75 （P 〈 0.05） for PIM2,PRISM had better fitting with the actual mortality than PIM2.The area under the receiver-operating characteristics （ROC） curve （95% confidence intervals,CI） were 0.829 （0.768-0.890） for PRISM and 0.758 （0.667-0.849） for PIM2.Conclusion Although the PIM2 test is less well calibrated overall,both PRISM and PIM2 can offer a good capacity for discriminating between survivors and moribund patients.The good performance of PRISM and PIM2 are demonstrated in predicting mortality probability in critically ill pediatric patients.

关 键 词：重症监护病房 预测 死亡率 

分 类 号：R720.597[医药卫生—急诊医学]