COMPARATIVE-ASSESSMENT OF PEDIATRIC INTENSIVE-CARE - A NATIONAL MULTICENTER STUDY
COMPARATIVE-ASSESSMENT OF PEDIATRIC INTENSIVE-CARE - A NATIONAL MULTICENTER STUDY
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DOI：
10.1097/00003246-199502000-00007
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发表时间：
1995-02-01
影响因子：
8.8
通讯作者：
MCDONNELL, J
中科院分区：
文献类型：
--
作者：
GEMKE, RJBJ;BONSEL, GJ;MCDONNELL, J
目的：儿科重症监护性能的比较评估，设计：开放性、前瞻性、多中心研究，环境：所有儿科重症监护病房（n = 10; 6例三级和4例非三级）在荷兰，患者：1063例连续住院，小于或等于18岁，在4个月期间，干预：无，测量和主要结果：有效性定义为观察到的死亡率与预期（儿科死亡风险评分衍生）死亡率的比值。有效性通过两个客观标准确定：死亡风险> 1%，或给予至少一种重症监护室（ICU）依赖性治疗。在总人口中，观察到的死亡率和预期的死亡率相似，医院之间的粗死亡率差异很大（平均7.1%，范围1%-10%），然而，在每个中心，观察到的和预期的死亡率相似（观察/预期死亡率的平均比率为0.99，范围为0.8至1.5），在三级护理中心，高风险患者中疾病严重程度校正的死亡率低于美国参考人群。奇怪的是，在低风险三级护理患者中，观察到的死亡率高于预期，这一组相对较高的死亡率可能是由于大量低风险三级护理患者患有严重的不可治愈的慢性疾病，平均有效ICU天数为72%，尽管发现单位之间的波动很大，（范围22%至95%），表明在几个中心，通过更好地选择需要ICU依赖性治疗的高风险患者，有效率可能会提高，结论：儿科ICU死亡率的差异在很大程度上是由疾病严重程度的差异解释的，在几个中心发现了高效率与足够的有效性相结合，表明在效率较低的中心，入院和出院的决定可能会得到改善。
Objective: Comparative assessment of performance of pediatric intensive care,Design: Open, prospective multicenter study,Setting: All pediatric intensive care units (n = 10; six tertiary and four nontertiary) in the Netherlands,Patients: 1063 consecutive unselected admissions, less than or equal to 18 yrs old, during a 4-month period,Interventions: None,Measurements and Main Results: Effectiveness was defined as the ratio of observed to expected (Pediatric Risk of Mortality-score-derived) mortality, Efficiency was determined by two objective criteria: mortality risk of >1%, or administration of at least one intensive care unit (ICU)-dependent therapy. In the total population, observed and expected mortality rates were similar, Between hospitals, crude mortality showed wide variations (mean 7.1%, range 1% to 10%), However, in each center, observed and expected mortality rates were similar (mean ratio of observed/expected mortality 0.99, range 0.8 to 1.5), In tertiary care centers, severity of illness-corrected mortality rates in high-risk patients were less than in a United States reference population, Paradoxically, in low-risk tertiary care patients, the observed mortality rate was higher than expected, The relatively high mortality rate in this group is probably the result of the large number of low-risk tertiary care patients suffering from severe, incurable chronic disease, The average number of efficient ICU days was 72%, although large fluctuations between units were found (range 22% to 95%), suggesting that in several centers efficiency rates might be improved by a better selection of high-risk patients requiring ICU-dependent therapies,Conclusions: Differences in mortality rates among pediatric ICUs were largely explained by differences in severity of illness, High efficiency rates combined with adequate effectiveness were found in several centers, indicating that admission and discharge decisions might be improved in less efficient centers.