A New Quantitative Triage System for Hospitalized Neonates to Assist with Decisions of Hospital Evacuation Priorities.
A New Quantitative Triage System for Hospitalized Neonates to Assist with Decisions of Hospital Evacuation Priorities.
复制标题
一种新的住院新生儿定量分诊系统，可协助决定医院疏散优先顺序。
DOI：
10.1017/s1049023x22000553
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发表时间：
2022
影响因子：
2.2
通讯作者：
Kazunori Imai
中科院分区：
文献类型：
--
作者：
稻留直子;野中弘美;米増直美;Kazunori Imai
简介住院新生儿由于对医疗资源的持续需求而容易受到自然和人为灾害的影响，并且当电力和医用气体供应变得不可靠时可能需要疏散到安全地点。在日本，住院新生儿分诊系统或新生儿简单分诊和快速治疗修订版 (START-Neo-R) 已用于确定新生儿是否处于适合运输的条件。然而，该量表并不能用于确定新生儿的疏散顺序，因为相当多的疏散人员被分为同一类别。研究目的为了解决这个问题，开发了一种新的分流系统，即新生儿救护分流（NEXT）。本研究测试了两种分诊的有效性和可重复性，并将其与住院新生儿标准化预后评分系统，即新生儿治疗干预评分系统 (NTISS) 进行比较。 方法在这项回顾性观察研究中，医生和护士使用 NEXT 和 START-Neo-R 每周两次独立评估在三级新生儿重症监护病房 (NICU) 住院的每位新生儿。 NEXT 系统包括六份关于过渡和运输期间所需医疗资源的调查问卷，提供 12 分制的综合分数。 START-Neo-R 根据疾病的严重程度和对医疗护理的依赖将新生儿分为五个级别。使用 Cohen 的 kappa 系数评估两个系统的评估者间可靠性，而使用 Spearman 相关系数评估 NTISS 的标准有效性。 结果 总体而言，对 162 名新生儿进行了 49 天的评估，产生了 1,079 名累积患者的分诊数据。 NEXT 分数和 START-Neo-R 排名在不同级别上都分散良好，没有在特定类别中过度积累。医生和护士之间的 NEXT（kappa 系数，0.973；95% 置信区间，0.969-0.976）和 START-Neo-R（kappa 系数，0.952；95% 置信区间，0.946-0.957）的评估者间可靠性足够高。 NEXT和START-Neo-R评分与NTISS评分的相关系数分别为0.889（P <.001）和0.850（P <.001）。结论 START-Neo-R和NEXT均具有良好的重复性，并且与NTISS所指示的新生儿严重程度具有良好的相关性。由于其在不同级别上的分数分布良好，NEXT 系统可能成为客观确定疏散优先级的强大工具。
IntroductionHospitalized neonates are vulnerable to natural and man-made disasters because of their persistent requirement for medical resources and may need to be evacuated to safe locations when electricity and medical gas supply become unreliable. In Japan, a triage system for hospitalized neonates, or the Simple Triage and Rapid Treatment for Neonates, Revised (START-Neo-R), has been used to determine whether neonates are in suitable conditions for transportation. However, this scale is not useful to determine the evacuation order of neonates because a considerable number of evacuees are classified into the same categories.Study ObjectiveTo solve this problem, a novel triage system, Neonatal Extrication Triage (NEXT) was developed. This study tested the validity and reproducibility of both triages and compared them with a standardized prognostic scoring system for hospitalized neonates, the Neonatal Therapeutic Intervention Scoring System (NTISS).MethodsIn this retrospective observational study, physicians and nurses independently assessed each neonate hospitalized at a tertiary neonatal intensive care unit (NICU) twice weekly using NEXT and START-Neo-R. The NEXT system comprises six questionnaires regarding medical resources required during transition and transportation, providing composite scores on a 12-point scale. The START-Neo-R classified neonates into five levels based on the severity of disease and dependence on medical care. Inter-rater reliability of both systems was assessed using Cohen’s kappa coefficient, whereas the criterion validity with NTISS was assessed using Spearman’s correlation coefficient.ResultsOverall, 162 neonates were assessed for 49 days, resulting in triage data for 1,079 accumulated patients. Both NEXT scores and START-Neo-R ranks were well-dispersed across different levels without excessive accumulation in specific categories. Inter-rater reliability of NEXT (kappa coefficient, 0.973; 95% confidence interval, 0.969-0.976) and START-Neo-R (kappa coefficient, 0.952; 95% confidence interval, 0.946-0.957) between physicians and nurses was sufficiently high. The correlation coefficient of NEXT and START-Neo-R scores with NTISS scores were 0.889 (P <.001) and 0.850 (P <.001), respectively.ConclusionsBoth START-Neo-R and NEXT had good reproducibility and correlation with the severity of neonates indicated by NTISS. With its well-dispersed scores across different levels, the NEXT system might be a powerful tool to determine the priority of evacuation objectively.