互联网医院危急患儿识别系统的构建及检测

Construction and detection of critical children identification system in internet hospital

目的构建基于儿科评估三角的互联网医院危急患儿识别系统,并评价系统评估准确性。方法按照系统开发程序构建基于儿科评估三角的互联网医院危急患儿识别系统。收集40个标准化案例,由4名互联网医院儿科医务人员应用系统判断患儿病情,采用模拟评估法评价系统的信度。由2名儿科分诊护士线下应用儿科评估三角及15名互联网医院儿科医务人员应用系统对644例患儿进行病情评估,采用诊断性试验评价系统评估准确性。结果系统4名评定者间信度ICC为0.665,重测信度为0.527~0.899(均P<0.05)。应用该系统对儿科评估三角中外观、呼吸、循环、识别危急患儿的灵敏度分别为70.0%、86.7%、50.0%、80.0%,特异度分别为79.3%、93.6%、99.7%、73.5%,约登指数分别为0.493、0.803、0.497、0.535(均P<0.05)。结论基于儿科评估三角的互联网医院危急患儿识别系统识别危急患儿的一致性、稳定性及准确性尚可,具有一定的临床价值。

Objective To construct an internet hospital critical children identification system based on Pediatric Assessment Triangle(PAT),and to evaluate its assessment accuracy.Methods According to the system development program,an internet hospital critical children identification system based on PAT was constructed.Forty standardized cases were collected,the condition of the children was judged using the system by 4 pediatric medical staff of internet hospital,and the reliability of the system was evaluated by simulation evaluation method.Then the condition of 644 children were assessed by 2 pediatric triage nurses using the PAT offline and 15 pediatric medical staff in internet hospitals using the system,and the diagnostic test evaluation system was used to evaluate the assessment accuracy of the system.Results The ICC of the 4 raters was 0.665,and the retest reliability was 0.527-0.899(all P<0.05).The sensitivity of the system for appearance,respiration,circulation and identification of critical children in the PAT was 70.0%,86.7%,50.0%,80.0%,and the specificity was 79.3%,93.6%,99.7%,73.5%,respectively.The Youden index was 0.493,0.803,0.497,0.535(all P<0.05).Conclusion The consistency,stability and accuracy of the internet hospital critical children identification system based on PAT are satisfactory,which has certain clinical value.