PEAT: PEDIATRIC EMERGENCY ASSESSMENT TOOL

PEAT：儿科紧急评估工具

• 批准号: 6352514
• 负责人: MARC H GORELICK
• 金额: $ 3.85万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-09-30 至 2002-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6352514
• 关键词: adolescence (12-20); age difference; child (0-11); clinical research; disease /disorder; emergency care; gender difference; health care quality; health science research analysis /evaluation; health services research tag; hospital utilization; human subject; method development; outcomes research; pediatrics; racial /ethnic difference

Evaluations of quality and outcomes of care in emergency medical services for children (EMSC), and comparisons of outcomes between EMSC systems or components of systems, require a method of adjusting for important differences in acuity between patient populations. No satisfactory method of risk adjustment currently exists that is broadly applicable to all EMSC patients. This study aims to develop a multivariable model, using predictor information available at the time of patient triage, to predict the probability of the need for different levels of emergency care. We plan a cohort study of 10,000 visits by children age 18 years or less to any of the eight acute care hospital emergency departments in Delaware, randomly selected from all visits over a 12 month period. Information will be obtained from review of ED records. Predictor variables of interest will include data collected at the time of patient triage and registration: age; date and time or visit; gender; race/ethnicity; chief complaint; triage vital signs; presence of significant past medical history (coded as positive or negative); current medications; mode of transportation; insurance coverage. A three level outcome will reflect the level of care provided: routine-standard nursing and physician care only; ED treatment-diagnostic tests performed or treatment provided in the ED, and patient discharged to home; and admission to the hospital (including transfer to another hospital or death in the ED). Using multivariate analytic techniques, including multinomial logistic regression, a predictive model will be developed in a subsample of 75 percent of the subjects, and validated in the remaining 25 percent. The creation of a new pediatric emergency assessment tool will permit risk stratification of patients according to the probability of requiring increasing intensity of services. Such a tool, after being validated in other settings in a future study, will permit adjustment for difference in patient acuity when evaluating outcomes of EMSC, or when comparing the performance of different systems of EMSC. It can also be used to generate expected distributions of levels of care for quality improvement purposes.

儿童紧急医疗服务（EMSC）的护理质量和结果的评估，以及EMSC系统或系统组件之间的结果比较，需要一种调整患者人群之间的重要差异的方法。 目前没有令人满意的风险调整方法广泛适用于所有EMSC患者。 本研究的目的是开发一个多变量模型，使用预测信息，在病人分诊时，预测的概率，需要不同级别的紧急护理。 我们计划进行一项队列研究，研究对象为特拉华州8家急症护理医院急诊科的10,000名18岁或18岁以下的儿童，这些儿童是从12个月内的所有就诊中随机选择的。 将通过审查艾德记录获得信息。关注的预测变量将包括在患者分诊和登记时收集的数据：年龄;日期和时间或访视;性别;人种/种族;主诉;分诊生命体征;存在显著既往病史（编码为阳性或阴性）;当前药物;运输方式;保险范围。 三级结局将反映所提供的护理水平：仅常规标准护理和医生护理;在艾德进行的艾德治疗诊断检查或提供的治疗，以及患者出院回家;以及入院（包括转至另一家医院或在艾德死亡）。 使用多变量分析技术，包括多项逻辑回归，将在75%的受试者的子样本中开发预测模型，并在剩余的25%中进行验证。 创建一个新的儿科急诊评估工具将允许根据需要增加服务强度的可能性对患者进行风险分层。 这样的工具，在其他设置在未来的研究中得到验证后，将允许调整患者的敏锐度差异时，评估结果的EMSC，或比较不同系统的EMSC的性能。 它还可以用于生成预期的护理水平分布，以提高质量。