Relationship of illness severity and length of stay to functional outcomes in the pediatric intensive care unit: A multi-institutional study
Relationship of illness severity and length of stay to functional outcomes in the pediatric intensive care unit: A multi-institutional study
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DOI：
10.1097/00003246-200004000-00043
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发表时间：
2000-04-01
影响因子：
8.8
通讯作者：
Roberson, PK
中科院分区：
文献类型：
--
作者：
Fiser, DH;Tilford, JM;Roberson, PK
目的：本研究的目的是通过使用多个机构的数据来建立疾病严重程度、住院时间和儿科重症监护室（PICU）功能结局之间的关系。我们假设功能结果评分、疾病严重程度和住院时间之间存在正相关。设计：本研究采用前瞻性多中心初始队列设计。设置：本研究在美国16个PICU进行，这些PICU是重症医学会儿科重症监护研究组的成员机构。患者：总共评估了11，106名患者，代表了连续12个月入住这些重症监护室的所有患者。测量：功能结果通过儿科总体性能类别（POPC）和儿科大脑性能类别（PCPC）量表进行测量。在基线和从PICU出院时评估两个量表。从出院评分中减去基线评分形成Delta评分。其他测量包括入院儿科死亡风险评分、年龄、手术状态、在PICU的住院时间和诊断。评估者间的可靠性通过使用一组10个标准化病例在两个场合6 monthsapart.Main结果：基线，出院，和δ POPC和PCPC结果评分与在PICU的住院时间和预测的死亡风险相关（p <0.01）。在多变量住院时间分析中纳入基线功能状态改善了测量拟合。在控制其他患者和机构特征后，儿童轻度基线脑功能缺损与PICU停留时间延长18%相关。POPC和PCPC评分的中度和重度基线缺陷预测住院时间增加30%至40%。在标准化的情况下，评分者之间达成共识，82%的分数与协议内一个相邻的类为99.7%的scores.Conclusions：这些数据建立目前的关系，POPC和PCPC的结果量表的基础上，多机构的数据。所报告的关系可用作评价临床方案或临床结果研究的参考值。
Objective: The purpose of this study was to establish relationships between illness severity, length of stay, and functional outcomes in the pediatric intensive care unit (PICU) by using multi-institutional data. We hypothesized that a positive relationship exists between functional outcome scores, severity of illness, and length of stay.Design: The study used a prospective multicentered inception cohort design.Setting: The study was conducted in 16 PICUs across the United States that were member institutions of the Pediatric Critical Care Study Group of the Society of Critical Care Medicine.Patients: In total, 11,106 patients were assessed, representing all admissions to these intensive care units for 12 consecutive months.Measurements: Functional outcomes were measured by the Pediatric Overall Performance Category (POPC) and Pediatric Cerebral Performance Category (PCPC) scales. Both scales were assessed at baseline and discharge from the PICU. Delta scores were formed by subtracting baseline scores from discharge scores. Other measurements included admission Pediatric Risk of Mortality scores, age, operative status, length of stay in the PICU, and diagnoses. Interrater reliability was assessed by using a set of ten standardized cases on two occasions 6 months apart.Main Results: Baseline, discharge, and delta POPC and PCPC outcome scores were associated with length of stay in the PICU and with predicted risk of mortality (p < .01). Incorporation of baseline functional status in multivariate length of stay analyses improved measured fit. Mild baseline cerebral deficits in children were associated with 18% longer PICU stays after controlling for other patient and institutional characteristics. Moderate and severe baseline deficits for both the POPC and PCPC score predict increased length of stay of between 30% and 40%. On the standardized cases, interrater consensus was achieved on 82% of scores with agreement to within one neighboring class for 99.7% of scores.Conclusions: These data establish current relationships for the POPC and PCPC outcome scales based on multi-institutional data. The reported relationships can be used as reference values for evaluating clinical programs or for clinical outcomes research.