Variations in definitions of mortality have little influence on neonatal intensive care unit performance ratings.
Variations in definitions of mortality have little influence on neonatal intensive care unit performance ratings.
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DOI：
10.1016/j.jpeds.2012.06.002
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发表时间：
2013-01
影响因子：
5.1
通讯作者：
Petersen, Laura A.
中科院分区：
文献类型：
--
作者：
Profit, Jochen;Gould, Jeffrey B.;Draper, David;Zupancic, John A. F.;Kowalkowski, Marc A.;Woodard, LeChauncy;Pietz, Kenneth;Petersen, Laura A.
测量不同死亡时间范围对一个大州的区域NICU绩效排名的影响。我们对24个三级新生儿重症监护病房的极低出生体重婴儿进行了横断面数据分析。我们测试了四种死亡率定义的影响：（1）入院至出生住院结束或长达366天的死亡;（2）出生12小时至出生住院结束或长达366天的死亡;（3）入院至28天的死亡;（4）出生12小时至28天的死亡。NICU通过量化其与风险调整后预期死亡率的偏差进行排名，并将其分为三个等级：前六名，后六名和中间。每种定义的风险调整死亡率存在广泛的机构间差异（观察值减去预期Z评分范围，-6.08至3.75）。然而，基于死亡率的新生儿重症监护室排名，以及它们对绩效等级的分类，在我们的每个时间范围内对所有机构都非常相似。在所有四种定义中，NICU等级相关性很高（>0.91）。很少有NICU相对于相邻层发生变化，定义发生变化，并且没有一个层发生变化。用于确定死亡率的时间框架对比较NICU性能的影响很小。
To measure the influence of varying mortality time frames on performance rankings among regional NICUs in a large state. We carried out cross-sectional data analysis of VLBW infants cared for at 24 level 3 NICUs. We tested the effect of four definitions of mortality: (1) deaths between admission and end of birth hospitalization or up to 366 days; (2) deaths between 12 hours of age and end of birth hospitalization or up to 366 days; (3) deaths between admission and 28 days; and (4) deaths between 12 hours of age and 28 days. NICUs were ranked by quantifying their deviation from risk-adjusted expected mortality and splitting them into three tiers: top six, bottom six, and in-between. There was wide inter-institutional variation in risk-adjusted mortality for each definition (observed minus expected Z-score range, -6.08 to 3.75). However, mortality-rate-based NICU rankings, and their classification into performance tiers, were very similar for all institutions for each of our time frames. Among all four definitions, NICU rank correlations were high (>0.91). Few NICUs changed relative to a neighboring tier with changes in definitions, and none changed by more than one tier. The time frame used to ascertain mortality had little effect on comparative NICU performance.
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