Intensive front-line protocols have improved survival in children with malignancies; however, intensive multimodal therapy of paediatric malignancies can be associated with a significant risk of serious adverse events...Intensive front-line protocols have improved survival in children with malignancies; however, intensive multimodal therapy of paediatric malignancies can be associated with a significant risk of serious adverse events. Common risk scores (PRISM, PRISM III, APACHE-II) fail to predict mortality in these patients. A retrospective chart analysis of 32 paediatric cancer patients admitted to the Paediatric Intensive Care Unit (PICU)-at the University Hospital of Saarland between January 2001 and December 2003 for life-threatening complications was performed. The aim of this study was to assess risk factors for short-term outcome (survival vs. non-survival when leaving the PICU) and to develop a risk score to estimate outcome in these patients. Overall survival was good (25 of 32 patients). Mortality rate was significantly related to leukaemia/lymphoma ( P =0.029), to the number of organ failures ( P < 0.0001), neutropenia ( P =0.001), septic shock ( P =0.025), mechanical ventilation ( P =0.01) and inotropic support ( P =0.01). Employing multiple logistic regression, the strongest predictor for poor outcome was the number of organ failures ( P < 0.05). A risk score (cut-off value: >3 points for non-survival)which included the following risk factors (non-solid tumour, number of organ failures ( n >2), neutropenia, septic shock, mechanical ventilation, and inotropicmedication) yielded a sensitivity of 7/7 (95% CI: 4.56-7.00), a specificity of 23/25 (95% CI: 18.49-24.75), a positive predictive value of 23/23 (95% CI: 19.80-23.00), and a negative predictive value of 7/9 (95% CI: 3.60-8.74) for the time of admission to the PICU. Conclusion:Although our risk of mortality score is of prognostic value in assessing short-term outcome in these patients, prospective validation in a larger study cohort is mandatory. Furthermore, it must be emphasised that this risk score must not be used for decision-making in an individual patient.展开更多
目的观察护理谵妄筛选评分法在麻醉后监测治疗室(post-anesthesia care unit,PACU)全麻苏醒期老年患者中应用的可行性。方法选择全麻下非心脏择期手术后转入PACU的老年(≥65岁)患者为研究对象,依次使用重症监护室意识模糊评估法和护理...目的观察护理谵妄筛选评分法在麻醉后监测治疗室(post-anesthesia care unit,PACU)全麻苏醒期老年患者中应用的可行性。方法选择全麻下非心脏择期手术后转入PACU的老年(≥65岁)患者为研究对象,依次使用重症监护室意识模糊评估法和护理谵妄筛查量表进行谵妄评估。以重症监护室意识模糊评估法为标准,评估护理谵妄筛查量表的敏感度和特异度。结果 303例患者纳入本研究,根据重症监护室意识模糊评估法诊断标准,本组的谵妄阳性率为25.7%。与非谵妄患者相比,谵妄患者中男性比例、年龄、手术时间、PACU留观时间均高于非谵妄患者(P<0.05)。与设定标准重症监护室意识模糊评估法相比,护理谵妄筛查量表的ROC曲线下面积为0.825。当诊断阈值≥1时,护理谵妄筛查量表的敏感度和特异度为65.3%和99.6%,与标准的一致性Kappa为0.707(P<0.01)。结论护理谵妄筛查量表是一种简便快捷、易于掌握的谵妄评估量表,可用于PACU老年患者谵妄评估的筛选。展开更多
文摘Intensive front-line protocols have improved survival in children with malignancies; however, intensive multimodal therapy of paediatric malignancies can be associated with a significant risk of serious adverse events. Common risk scores (PRISM, PRISM III, APACHE-II) fail to predict mortality in these patients. A retrospective chart analysis of 32 paediatric cancer patients admitted to the Paediatric Intensive Care Unit (PICU)-at the University Hospital of Saarland between January 2001 and December 2003 for life-threatening complications was performed. The aim of this study was to assess risk factors for short-term outcome (survival vs. non-survival when leaving the PICU) and to develop a risk score to estimate outcome in these patients. Overall survival was good (25 of 32 patients). Mortality rate was significantly related to leukaemia/lymphoma ( P =0.029), to the number of organ failures ( P < 0.0001), neutropenia ( P =0.001), septic shock ( P =0.025), mechanical ventilation ( P =0.01) and inotropic support ( P =0.01). Employing multiple logistic regression, the strongest predictor for poor outcome was the number of organ failures ( P < 0.05). A risk score (cut-off value: >3 points for non-survival)which included the following risk factors (non-solid tumour, number of organ failures ( n >2), neutropenia, septic shock, mechanical ventilation, and inotropicmedication) yielded a sensitivity of 7/7 (95% CI: 4.56-7.00), a specificity of 23/25 (95% CI: 18.49-24.75), a positive predictive value of 23/23 (95% CI: 19.80-23.00), and a negative predictive value of 7/9 (95% CI: 3.60-8.74) for the time of admission to the PICU. Conclusion:Although our risk of mortality score is of prognostic value in assessing short-term outcome in these patients, prospective validation in a larger study cohort is mandatory. Furthermore, it must be emphasised that this risk score must not be used for decision-making in an individual patient.
文摘目的观察护理谵妄筛选评分法在麻醉后监测治疗室(post-anesthesia care unit,PACU)全麻苏醒期老年患者中应用的可行性。方法选择全麻下非心脏择期手术后转入PACU的老年(≥65岁)患者为研究对象,依次使用重症监护室意识模糊评估法和护理谵妄筛查量表进行谵妄评估。以重症监护室意识模糊评估法为标准,评估护理谵妄筛查量表的敏感度和特异度。结果 303例患者纳入本研究,根据重症监护室意识模糊评估法诊断标准,本组的谵妄阳性率为25.7%。与非谵妄患者相比,谵妄患者中男性比例、年龄、手术时间、PACU留观时间均高于非谵妄患者(P<0.05)。与设定标准重症监护室意识模糊评估法相比,护理谵妄筛查量表的ROC曲线下面积为0.825。当诊断阈值≥1时,护理谵妄筛查量表的敏感度和特异度为65.3%和99.6%,与标准的一致性Kappa为0.707(P<0.01)。结论护理谵妄筛查量表是一种简便快捷、易于掌握的谵妄评估量表,可用于PACU老年患者谵妄评估的筛选。
