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Validating a Necrotizing Enterocolitis (NEC) Risk Index for Neonates

验证新生儿坏死性小肠结肠炎 (NEC) 风险指数

基本信息

批准号：
8198885
负责人：
Sheila Maria Gephart
金额：
$ 3.14万
依托单位：
UNIVERSITY OF ARIZONA
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-08-10 至 2012-05-14
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8198885
关键词：
Abdomen Accounting Acute Affect Apgar Score Birth Records Caring Cerebral Palsy Cessation of life Clinical Clinical Decision Support Systems Cognitive Communication Complex Complication Consultations Data Set Deterioration Development Diagnosis Discipline of Nursing Disease Disease Progression Early identification Electronics Elements Emergency Situation Ensure Environment Failure Future Gastrointestinal Diseases Gestational Age Goals Hospital Costs Hospitalization Hour Image Impaired cognition Impairment Indium Individual Infant Inflammatory Information Systems Intervention Intestinal Perforation Intestines Lead Life Literature Location Low Birth Weight Infant Lower Body Negative Pressure Measures Medical Methodology Methods Mission Morbidity - disease rate Necrosis Necrotizing Enterocolitis Neonatal Neonatal Intensive Care Units Neonatal Mortality Neurodevelopmental Impairment Newborn Infant Nurses Operative Surgical Procedures Outcome Outcomes Research Patients Perinatal Physiology Premature Infant Preventive Intervention Process Readiness Research Resource Allocation Resources Review Literature Risk Risk Assessment Sampling Sensitivity and Specificity Severity of Illness Index Site Specialist Staging Symptoms Technology Testing Time Translating United States Validation base clinical practice cost feeding gastrointestinal improved indexing mortality neonatal morbidity neonate nutrition point of care prenatal programs research to practice respiratory standard measure tool

项目摘要

DESCRIPTION (provided by applicant): Background: Necrotizing Enterocolitis (NEC) is the most common gastrointestinal emergency for premature infants. It is a costly disease and a primary cause of neonatal morbidity and mortality. Infants with NEC who are managed surgically stay in the Neonatal Intensive Care Unit (NICU) over 90 days on average, are among the most likely to stay more than 6 months and may suffer significant long-term impairments to their bowel, nutrition and cognitive abilities. If NEC symptoms are identified soon enough, feedings can be stopped to limit disease progression and transport to a surgical center facilitated. A risk index may improve early recognition of NEC however none is available. The purpose of this research is to validate a NEC risk index, GUTCHECK, to predict the likelihood of NEC in at-risk neonates to enhance surveillance, recognize NEC while it can be managed medically and decrease failure to rescue. Specific Aims: The specific aims of this research are to: (1) assess the content validity of the GUTCHECK index and (2) test the intra-individual reliability and predictive validity of the index using an existing national perinatal dataset. Significance: Early identification of infants at risk for NEC can lead to fewer surgical interventions, lower morbidity, lower mortality, lower costs, and better resource allocation. Methodology: To achieve Aim 1, an E-Delphi will be used to assess the extent to which experts agree on risk elements in GUTCHECK. To achieve Aim 2, a two stage process of validation using an existing national dataset will determine GUTCHECK's sensitivity and specificity. Intra-individual reliability will be tested using a random sample of cases scored by one observer at two time points. Expected Results: The expected result of this research is an intra-individually reliable, valid and predictive risk index for NEC. Implications for Further Research: Future studies will evaluate the inte-rater reliability of GUTCHECK. Then it will be integrated into a clinical decision support system to integrate risk elements captured from prenatal, maternal, and birth records to provide a risk score in real time. An alert can then be generated if values rise above a preset cut-point. Future studies will measure the effect of using GUTCHECK on early recognition of NEC and improved handoff communication of NEC risk. Relevance to NINR Mission: The development, validation and future integration of GUTCHECK into automated clinical decision support will use technology to translate research into practice at the point of care. In this way, GUTCHECK may improve NEC outcomes by helping clinicians recognize NEC risk and intervene early. PUBLIC HEALTH RELEVANCE: Necrotizing enterocolitis (NEC) is the most common catastrophic gastrointestinal disease that affects newborns, accounting for 3000 deaths a year and nearly one-fifth of neonatal hospital costs in the US. The goal of this study is to validate a risk measure for NEC, GUTCHECK, to help clinicians recognize NEC in its early stages and facilitate appropriate and prompt medical management.

描述（由申请人提供）：背景：坏死性小肠结肠炎（NEC）是早产儿最常见的胃肠道急症。这是一种代价高昂的疾病，也是新生儿发病和死亡的主要原因。接受手术治疗的NEC婴儿平均在新生儿重症监护室（NICU）停留超过90天，最有可能停留超过6个月，并可能对其肠道，营养和认知能力造成严重的长期损害。如果NEC症状很快被发现，可以停止喂养以限制疾病进展，并将其运送到外科中心。风险指数可以提高NEC的早期识别，但没有可用的。本研究的目的是验证NEC风险指数GUTR，以预测高危新生儿NEC的可能性，以加强监测，识别NEC，同时可以通过医学方法进行管理，减少抢救失败。具体目标：本研究的具体目的是：（1）评估GUTR指数的内容效度和（2）使用现有的国家围产期数据集测试该指数的个体内可靠性和预测效度。重要性：早期识别NEC风险的婴儿可以减少手术干预，降低发病率，降低死亡率，降低成本，并更好地分配资源。方法：为了实现目标1，将使用E-Delphi评估专家对GUTR风险因素的一致程度。为了实现目标2，使用现有的国家数据集进行两阶段验证过程将确定GUTR的灵敏度和特异性。将使用由一名观察员在两个时间点评分的病例随机样本检验个体内可靠性。预期结果：本研究的预期结果是NEC的个体内可靠，有效和预测的风险指数。进一步研究的意义：未来的研究将评估评估者之间的可靠性GUTRIGHTS。然后，它将被集成到临床决策支持系统中，以整合从产前、孕产妇和出生记录中捕获的风险元素，从而提供真实的风险评分。如果数值超过预设的临界点，则可以生成警报。未来的研究将衡量使用GUTRIPs对NEC早期识别和改善NEC风险的交接沟通的影响。与NINR使命的相关性：开发、验证和未来将GUTRIGHT集成到自动化临床决策支持中，将使用技术将研究转化为护理点的实践。通过这种方式，GUTR可以通过帮助临床医生识别NEC风险并早期干预来改善NEC结果。公共卫生关系：坏死性小肠结肠炎（NEC）是影响新生儿的最常见的灾难性胃肠道疾病，每年造成3000人死亡，占美国新生儿医院费用的近五分之一。本研究的目的是验证NEC的风险度量，GUTR，以帮助临床医生在早期阶段识别NEC，并促进适当和及时的医疗管理。