患者报告结局测量在重症患儿院内照护中应用的范围综述

A scoping review of patient-reported outcome measures applied in inpatient care of critically ill children

目的 对重症患儿在院期间进行的基于患者报告结局的健康测量的应用相关文献进行范围审查,剖析该领域目前的研究特点和进展。方法 以Arksey范围综述方法学为框架,系统检索包括PubMed、The Cochrane Library、CINAHL、Embase、中国知网、万方数据库、维普中文科技期刊数据库和中国生物医学文献数据库,对各数据库建库至2023年1月25日的中英文原始研究文献进行检索和筛选,汇总纳入文献信息并分析。结果 最终纳入文献19篇。基于患者报告结局的重症患儿院内健康测量主要应用于以疼痛和心理健康为主的症状功能评估、健康相关生活质量评估,以及临床干预效果评价。重症监护(intensive care unit ICU)期间的自我报告主要是单维疼痛强度评估,其他更多基于自我报告的测量评价集中在ICU转出前后至出院前。临床以联合使用多种或多维测量工具为主,工具多为普适性,多数工具存在显著的年龄覆盖范围问题。结论 在重症患儿院内照护过程中对其自我报告的健康结局进行标准化测量是提高医疗照护质量、促进患儿院外康复和健康成长的重要保障。但目前重症患儿院内患者报告结局测量的研究与实践均处于较初级阶段,有必要扩大重症患儿院内自我报告健康结局的应用领域、时间范围和形式等,谨慎选择科学全面的患者报告结局测量工具,强化院内基线测量并开展高质量纵向追踪研究,以全面描绘重症患儿的全程健康,提高患儿长期生存质量。

Objective To conduct a scoping review of the literature related to the application of patient-reported outcome measures performed during the hospitalization of children experienced intensive care,and to analyze characteristics and progress in this field.Methods Based on the Arksey scoping review methodology framework,a systematic search was conducted in PubMed,The Cochrane Library,CINAHL,Embase,CNKI,Wanfang,VIP,and SinoMed,and the original research literature in English and Chinese from the establishment of each database to January 25,2023 was searched and screened,and the literature information was summarized and analyzed.Results A total of 19 articles were included, andthe results showed that in-hospital patient-reported outcome measures for children experiencedintensive care were mainly used in assessments of symptoms and functions focusing on pain and mental health,health-related quality of life, and effectiveness of clinical interventions. Self-reports during intensive care unit (ICU)were primarily one-dimensional pain intensity assessments, and other more self-reported measures were performedbefore and after ICU transfer and before hospital discharge. Multiple or multidimensional measurements werewidely used in the clinic, and the instruments were mostly universal, with most having significant age coverageissues. Conclusion Standardized measurement of self-reported health outcomes during inpatient care of critically illchildren is an important guarantee to improve the quality of medical care and promote out-of-hospitalrehabilitationand healthy growth of children.However, the current researches and practices of measuring outcomesreported by patients in hospital for critically ill children are at a relatively early stage. It is necessary to expand itsapplication, temporal scope, and formats of self-reported health outcomes in hospital for critically ill children,carefully select scientific and comprehensive tools for patient reported outcomes, strengthen in-hospital baselinemeasurement and conduct high-quality longitudinal follow-up studies, in order to comprehensively describe theentire health status and change of critically ill children, and improve their long-term quality of life.