简化小儿危重病例评分法的临床应用

Clinical application of simplified pediatric critical illness scoring system

目的 简化小儿危重病例评分法。分析用简化评分系统评估患儿病情的效果 ,以期更好地适用于基层医院。方法 对 14家三级医院的 10 36例患儿 ,于入院第 1、3、7天及出院或死亡时进行小儿危重病例评分。原评分 10项指标中 ,依次减去动脉氧分压 (PaO2 )和pH、BUN或肌酐、血钠和血钾 ,余 8、7、5项指标 ,原评分分别乘以 0 8、0 7、0 5形成新的评分系统。分析简化评分系统评估病情与原评估方法的符合率 (应 >80 % )及二者的相关性 ,观察简化后评分体系的病死率变化与原评分法是否一致。结果 首次评分减去 2、3、5项指标后 ,与原病情评估一致的病例分别为 82 6 % (85 6 /10 36 )、80 7% (836 / 10 36 )、6 9 9% (72 4 / 10 36 ) ,显示用 5项指标评估病情符合率较低。简化后第 3、7天和末次评分 ,与原病情评估符合率为 81 5 %～ 97 1%。简化前、后有良好相关性 (r=0 6 2 9～ 0 94 8,P均 <0 0 0 1)。简化后 4次评分 ,非危重、危重、极危重组病死率差异有非常显著性 (χ2 =86 13～74 0 33,P均 <0 0 0 1) ,即评分越低 ,病死率越高。在同一病情状态下 ,简化前后的病死率变化不大。如极危重组首、末次评分原病死率为 2 9 8%、6 7 4 % ,简化后病死率分别为 30 0 %～ 2 7 9%、6 6 3%～6 4 4 %。

Objective To simplify the Pediatric Critical Illness Scoring (PCIS), to evaluate the simplified PCIS and to make the simplified scoring system applicable in the grassroots hospitals. Methods Totally 1 036 patients were scored by PCIS on 1,3,7 and the last (discharged or dead) hospital days. The PCIS has 10 items. The full score is 100. The scores ～100, ～80, ～70 represent non-serious, serious, and extremely serious patients′ condition. The PaO_2 and pH (2 items), BUN or creatinine (3 items), plasma sodium and potassium (5 items) were deleted from PCIS′s 10 items in turn. The remaining 8, 7, and 5 items were applied as new scoring system after the original scores were multiplied by 0.8, 0.7, and 0.5. The simplified PCIS was evaluated by comparing the patients′ condition that was assessed by PCIS. The consistency rate of patients′ condition that was obtained by using PCIS and simplified PCIS should be over 80%. The mortality of non-serious, serious, and extremely serious groups that were defined by using PCIS and simplified PCIS was observed and compared. Results When 2, 3 and 5 items were deleted from the PCIS on d1 scoring the consistency rates of the patients′ condition were 82.6%, 80.7%, and 69.9%. While 5 items remained on d1 scoring the consistency rate was lower than 80%. When the same 2, 3 and 5 items were deleted from PCIS on d3, d7 and last scoring, the consistency rates of the patients′ condition were 81.5%～97.1%. The PCIS and simplified PCIS had a close correlation ( r =0.629～0.948, P< 0.001). In PCIS the mortality rates of non-serious, serious and extremely serious patients were significantly different. When simplified PCIS was used, the mortality rates of the three groups also had significant differences (χ 2 =86.13～740.33 , P< 0.001). Within a group of patients with the same condition, the mortality rates were not significantly different for PCIS and simplified PCIS. For instance, on d1 and last scoring, the mortality rates of extremely serious patients were 29.8%, 67.3% for PCIS and 30.0%～27.9%, 66.3%～64.4% for simplified PCIS. Conclusion When 2 items (PaO_2 and pH) were deleted from d1 PCIS scoring and 5 items (PaO_2 and pH, BUN or creatinine, plasma sodium and potassium) were deleted from d3, d7, and last PCIS scoring, the results of assessment of patients′ condition were basically the same as those of PCIS. The consistency rates of PCIS and simplified PCIS were >80%. When simplified PCIS was applied, mortality rates of non-serious, serious, and extremely serious patients were significantly different that were the same as those of PCIS. In patients with the same condition, the mortality rates were not significantly different between the simplified PCIS and PCIS.