The Modified Clinical Progression Scale for Pediatric Patients: Evaluation as a Severity Metric and Outcome Measure in Severe Acute Viral Respiratory Illness.
The Modified Clinical Progression Scale for Pediatric Patients: Evaluation as a Severity Metric and Outcome Measure in Severe Acute Viral Respiratory Illness.
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DOI：
10.1097/pcc.0000000000003331
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发表时间：
2023-12-01
期刊：
影响因子：
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开发、评估和探索使用儿科序数评分作为因病毒性呼吸道感染引起的急性缺氧性呼吸衰竭住院儿童的潜在临床试验结果指标。我们修改了世界卫生组织儿科患者临床进展量表 (CPS-Ped)，并在入院时、第 2-4 天、第 7 天和第 14 天分配了 CPS-Ped。我们使用竞争风险回归确定了临床改善的预测因素（第 14 天 CPS-Ped ≤ 2 或减少 3 个点），并将临床改善与住院时间 (LOS) 和无呼吸机天数进行了比较。我们估计样本量（80% 功效）可检测到 15% 的临床改善。北美儿科医院。接受重症监护的三组急性缺氧性呼吸衰竭儿科患者：两种流感（儿科重症监护流感 [PICFLU]，n = 263，31 个中心；PICFLU 疫苗有效性 [PICFLU-VE]，n = 143，17 个中心）和 1 个 COVID-19（n = 237，47 个中心）。没有任何。 PICFLU、PICFLU-VE 和 COVID-19 的有创机械通气率分别为 71.4%、32.9% 和 37.1%，所有三个队列的死亡率均低于 5%。最大 CPS-Ped（0 = 呼吸基线至 8 = 死亡）与医院 LOS 呈正相关（p < 0.001，所有队列）。在这三个队列中，许多患者的 CPS-Ped 入院后恶化（39%、18% 和 49%），一些患者进展为有创机械通气或死亡（19%、11% 和 17%）。尽管如此，队列中超过 76% 的患者在第 14 天出现临床改善。与死亡率（n > 21,000，全部）和无呼吸机天数相比，使用 CPS-Ped 检测临床改善百分比增加的每组样本量是可行的（流感 15%，n = 142；10%，n = 225；COVID-19，15% n = 208） （流感 15%，n = 167）。 CPS-Ped 可用于描述因病毒感染而患有急性呼吸衰竭的住院儿童和青少年的病程和临床改善阈值。该结果测量可以切实用于临床试验来评估院内康复情况。
To develop, evaluate, and explore the use of a pediatric ordinal score as a potential clinical trial outcome metric in children hospitalized with acute hypoxic respiratory failure caused by viral respiratory infections. We modified the World Health Organization Clinical Progression Scale for pediatric patients (CPS-Ped) and assigned CPS-Ped at admission, days 2–4, 7, and 14. We identified predictors of clinical improvement (day 14 CPS-Ped ≤ 2 or a three-point decrease) using competing risks regression and compared clinical improvement to hospital length of stay (LOS) and ventilator-free days. We estimated sample sizes (80% power) to detect a 15% clinical improvement. North American pediatric hospitals. Three cohorts of pediatric patients with acute hypoxic respiratory failure receiving intensive care: two influenza (pediatric intensive care influenza [PICFLU], n = 263, 31 sites; PICFLU vaccine effectiveness [PICFLU-VE], n = 143, 17 sites) and one COVID-19 (n = 237, 47 sites). None. Invasive mechanical ventilation rates were 71.4%, 32.9%, and 37.1% for PICFLU, PICFLU-VE, and COVID-19 with less than 5% mortality for all three cohorts. Maximum CPS-Ped (0 = home at respiratory baseline to 8 = death) was positively associated with hospital LOS (p < 0.001, all cohorts). Across the three cohorts, many patients’ CPS-Ped worsened after admission (39%, 18%, and 49%), with some patients progressing to invasive mechanical ventilation or death (19%, 11%, and 17%). Despite this, greater than 76% of patients across cohorts clinically improved by day 14. Estimated sample sizes per group using CPS-Ped to detect a percentage increase in clinical improvement were feasible (influenza 15%, n = 142; 10%, n = 225; COVID-19, 15% n = 208) compared with mortality (n > 21,000, all), and ventilator-free days (influenza 15%, n = 167). The CPS-Ped can be used to describe the time course of illness and threshold for clinical improvement in hospitalized children and adolescents with acute respiratory failure from viral infections. This outcome measure could feasibly be used in clinical trials to evaluate in-hospital recovery.
DOI：
10.7759/cureus.12290
发表时间：
2020-12-26
期刊：
Cureus
影响因子：
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作者：
Nasir N;Mahmood F;Habib K;Khanum I;Jamil B
通讯作者：
Jamil B
影响因子：
2.6
作者：
Gupta S;Sankar J;Lodha R;Kabra SK
通讯作者：
Kabra SK
影响因子：
8.1
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