转运儿童早期预警评分在院间转运患者病情评估中的应用

Application of the transport pediatric early warning score in evaluating the severity of inter-hospital transportation patients

目的探讨转运儿童早期预警评分(transport pediatric early warning score,TPEWS)对院间转运患者病情评估的应用价值.方法采用回顾性分析方法,对2018年1月至2019年7月重庆医科大学附属儿童医院通过院间转运入院且年龄>28 d患者的资料进行分析;根据患者转运直接收入病房的不同,分为儿科重症监护病房(pediatric intensive care unit,PICU)住院组患者与普通专科住院组患者;追踪所有患者30 d内的转归及预后,根据预后结果分为死亡组患者与存活组患者,分别对各分组患者进行TPEWS评分及比较,并运用受试者工作特征曲线(ROC曲线)分析患者转运直接收入PICU住院与30 d内死亡风险的最佳界值.结果排除1例本不宜转运但由于社会因素于转运途中死亡的患者,最终纳入392例患者,其中男251例(64.0%),女141例(36.0%);年龄29 d^182个月(中位数15个月);转运半径4~440 km(中位数30 km);转运直接收入PICU住院109例患者,转运收入普通专科住院283例患者.PICU住院组患者转运前、转运后及入院时不同时段的TPEWS中位数分值(6分、4分、4分)显著高于普通专科住院患者中位数分值(2分、1分、1分),差异有统计学意义(Z=-5.320,Z=-5.644,Z=-5.747,P均<0.001);PICU住院组患者的年龄中位数(11个月)明显小于普通专科住院组的年龄中位数(21个月),但两组比较差异无统计学意义(Z=-2.530,P>0.05);两组患者性别构成比、死亡例数的比较差异均无统计学意义(χ^2=1.121,χ^2=34.342,P均>0.05).追踪所有患者30 d内转归,其中死亡患者20例(5.1%),存活患者372例(94.9%).死亡组患者转运前、转运后及入院时不同时段的TPEWS中位数分值(6分、4分、4分)显著高于存活组患者中位数分值(均2分),差异有统计学意义(Z=-5.320,Z=-5.644,Z=-5.747,P均<0.001);死亡组患者的年龄中位数(7个月)明显小于存活组的年龄中位数(15个月),但两组比较差异无统计学意义(Z=-1.900,P>0.05);两组患者性别构成比差异无统计学意义(χ^2=3.722,P>0.05).运用ROC曲线判定TPEWS≥3.5分时为院间转运患者直接收入PICU住院及30 d内死亡风险增高的最佳界值.结论TPEWS对评估院间转运患者的病情、识别危重症患者和及时收入PICU治疗有一定价值.

Objective To explore the clinical application value of the transport pediatrie early warming score(TPEWS)in evaluating the inter-hospital transportation patients.Methods The transport data and clinical materials of these transport patients aged over 28 days from January 1,2018 to July 31,2019 were analyzed by retospective analysis.According to the differences of adnmission wards,all the patients were transported to the pediatric intensive care unit(PICU)or general special wards in the Children's Hospital of Chongqing Medical University.The patients'outcomes within 30 days were fllowed up,and the patients were divided into the death group and survival group according to the outcomes.The TPEWS before and after inter-hospital transpotation,and on admission were assessed and compared.The optimal cut-off point between hospitalization of PICU and the death risk wa analyzed by the receiver operating characteristic curve(ROC).Results One patient who was not supposed to be transported and died in transit was excluded.A total of 392 patients were fnally enrolled to the study,including 251 males(64.0%)and 141 female(36.0%).The age rang from 29 days to 182 months(median 15 months).The transfer radius was within4-440 km(median 30 km),109 cases were straightly admitted into PICU,and 283 cascs were hospitalized into dfferent special wards.The TPEWS median scores before transport(6),after tranbport(4)and on admission(4)in PICU patients were observably higher than the TPEWS median scores(2,1,1)in these special wards patients,which had staistially significant differences(Z=-5.320,Z=-5.644,Z=-5.747,P<0.001).The median age(11 months)of PICU patients was significantly younger than that in the general inpatient group(21 months),but the difference between the two groups was not statistically significant(Z=-2.530,P>0.05).In addition,the sex composition and the mumber of deaths between the two groups showed ststically no sgificant dfferenes(χ^2=1.121,χ^2=34.342,P>0.05).20 patients(5.1%)were dead and 372 patients(94.9%)were survival within 30 days of follow-up.Compared with the TPEWS median scores(2)of the survival group,the patients in death group had higher TPEWS median scores before transport(6),after transport(4)and on admission(4),which had staistially significant diferences(Z=-5.320,Z=-5.644,Z=-5.747,P<0.001).The median age(7 months)of patients in the death group was sigificantly younger than that in the survival group(15 months),but the diference between the two groups was not satistically signifcant(Z=-1.900,P>0.05).But the sex composition showed stisticallyy no signifcant dfferences(χ^2=3.722,P>0.05).When the TPEWS score≥3.5,the patients were likely to admiting into the PICU and the death risk of patients was inereased with the ROC curve.Conclusion The TPEWS had a certain value in evaluating and identifying critical ill patients with inter-hospital transportation,and timely tarnsfrering them to PICU for treatment.