摘要
目的探讨儿童早期预警评分在判断血液肿瘤患儿病情变化的预测价值及临床可行性。方法对2017年7月至2018年3月入住上海市某三甲专科医院血液肿瘤病区的患儿为研究对象。对所有患儿每4 h进行一次儿童早期预警评分(pediatric early warning score,PEWS),同时记录评分耗时、将因病情危重转ICU或死亡的患儿设为病例组,以1∶5的比例匹配对照组,即未发生结局事件的患儿。使用受试者工作特征曲线、约登指数等进行统计分析。结果结局事件前24 h内PEWS最高值用于预测"因病情危重转ICU"的最佳截断点为2.25分、ROC曲线下面积(area under ROC curve,AUC)为0.85以上用于预测"死亡"的最佳截断点为6.50分、AUC为0.99以上。每位患儿进行一次PEWS评估平均需要(1.77±1.16)min,试点病区所有患儿进行PEWS评估的总时间为4.58 h/d。结论使用PEWS评分可准确预测血液肿瘤患儿发生病情危重或死亡;但若将PEWS评估常规应用于病区所有患儿,需要优化人力调配,或者根据专科截断点调整评估方案。
Objective To explore the predictive value and clinical feasibility of pediatric early warning score(PEWS)in judging the deterioration of children with hematological tumors.Methods All the pediatric patients admitted in the pediatric hematological and ontological department of a tertiary pediatric hospital in Shanghai from July 2017 to March 2018 were assessed every 4 hours by using the PEWS,and the actual consuming time was documented simultaneously.The patients who were transferred to PICU due to clinical deterioration or dead was analyzed as case group,and the patients with normal discharge were analyzed as control group,a 1:5 ratio was used to match the number of the control group,which was the children with no expected ending.The ROC curve and youden index were used for statistical analysis.Results The optimal cut-off point of highest PEWS within 24 hours before ending point was 2.25 for prediction of transferring to PICU due to clinical deterioration,and area under ROC curve(AUC)was over 0.85.For prediction of death,the cut-off point of highest PEWS was 6.50,and the AUC was over 0.99.The average evaluation time of PEWS for each patient was 1.77±1.16 min,and the total time of PEWS evaluation in the department was 4.58 hours per day.Conclusions PEWS could provide a precise prediction of the clinical deterioration or death for pediatric patients with the hematological tumor.However,if the PEWS evaluation is routinely applied to all children in the department,it is necessary to optimize the allocation of nursing human resources,or adjust PEWS evaluation protocol according to specific cut off points.
作者
周芬
潘慈
高怡瑾
沈南平
张冰花
何梦雪
ZHOU Fen;PAN Ci;GAO Yijin;SHEN Nanping;ZHANG Binghua;HE Mengxue(Hematology and Oncology Department,Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University,Shanghai 200127,China;Nursing Department,Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University)
出处
《解放军护理杂志》
CSCD
北大核心
2019年第4期6-10,共5页
Nursing Journal of Chinese People's Liberation Army
基金
上海交通大学医学院护理科研重点项目(Jyhz1805)
上海交通大学医学院附属上海儿童医学中心院级科研课题(HL-SCMC2017-2)
关键词
儿童早期预警评分
儿童
肿瘤
预测
pediatric early warning score
child
oncology
prediction
