PHYSIOLOGICAL SEVERITY INDEX FOR NEONATAL INTENSIVE CARE

新生儿重症监护室（NICU）已经证明了显着 有效降低新生儿死亡率和发病率。 然而， 机构之间生存和结果的显著差异， 当调整出生体重、性别和种族时， 这些差异不仅在临床上很重要， 还可能对公共卫生甚至经济造成严重影响， 对NICU护理的看法极高。 有必要 制定疾病严重程度指数，以便准确 医院之间NICU护理的比较研究， 地区和时间。 严重程度量表已开发用于 成人和儿科重症监护依赖于程度， 个别患者的生理异常。 这些分数 在面对治疗方式的变化时， 或诊断惯例。 这样的规模还没有 试图进行新生儿重症监护，部分原因是 一个强有力的预测因素，出生体重。 我们建议 制定这样一个基于生理学的疾病严重程度指数， 新生儿重症监护在我们的三年内超过两年， NICU系统。 研究战略将是开发一种使用 专家小组和名义小组技术。 评分项目将 包括基本物理和实验室测量。 后 测试的可靠性，它将被应用前景之一， 在我们的三个NICU。 有效性将由 预测死亡率和不良结局的能力。 它还将 与其他严重程度标志物进行比较，包括 治疗强度，护理敏锐度，重症监护并发症 护理（院内败血症）和住院费用。 进一步 将通过多变量逐步建模来细化。 的 指数的成功将根据其解释能力来评估， 已知主要风险因素后剩余的方差 （出生体重、种族、性别、复数）。 的 专家小组随后将再次开会，评估由此产生的比额表 并建议最终修订。

Neonatal Intensive Care Units (NICUs) have proven remarkably effective in lowering neonatal mortality and morbidity. Yet, marked variations in survival and outcome among institutions have been demonstrated when adjusted for birthweight, sex, and race. Not only are these disparities significant clinically, but they may also have serious public health and even economic impact in view of the extremely high most of NICU care. It is essential to develop a severity of illness index in order to permit accurate comparative studies of NICU care between hospitals, across regions, and over time. Severity scales have been developed for adult and pediatric intensive care which rely on the degree on physiologic abnormality of the individual patients. These scores tend to be robust in the face of variations in therapeutic style or diagnostic conventions. Such scales have not yet been attempted for neonatal intensive care, in part because of the availability of a strong predictor, birthweight. We propose to develop such a physiology based severity of illness index for neonatal intensive care over a two year period within our three- NICU system. The research strategy will be to develop an instrument using an expert panel and nominal group techniques. Score items will include basic physical and laboratory measurements. After testing reliability, it will be applied prospectively for one year in our three NICUs. Validity will be assessed by the ability to predict mortality and adverse outcomes. It will also be compared against other markers of severity including therapeutic intensity, nursing acuity, complications of intensive care (nosocomial sepsis), and hospital charges. Further refinement will come through multivariate stepwise modeling. The success of the index will be assessed by it ability to explain the variance remaining after the known major risk factors (birthweight, race, sex, plurality) have been entered. The expert panel will then reconvene to evaluate the resulting scale and recommend final revisions.