不同测量工具在先天性心脏病术后患儿危重程度评估中应用效果的比较

摘要

Objective:To evaluate the applicability of six illness-severity scoring systems to assess children with Congenital Heart Diseases (CHD). Methods:Intra-class Correlation Coefficient (ICC) was used to measure the inter-rater reliability. Area under ROC curve and Hosmer-Lemeshow goodness of fit test were used to assess the performance of the instruments. Results:1284 children with congenital heart diseases were included. The discriminatory power of the specific score for CHD was better than the others (AUC>0.75). The calibration capability of PRISM III, PIM2, and specific score for CHD were tolerable (P>0.05) . Conclusion:The specific score for CHD is better than non-specific instruments for the evaluation of children with CHD.%目的:比较6项危重程度评估工具应用于先心病术后患儿病情评估中的效果.方法:比较6项工具内涵并采用t检验、ROC曲线下面积、Hosmer-Lemeshow拟合优度检验等比较工具应用效果.结果:纳入1284例患儿,6项工具在构建方式、评分内容、评分应用层面存在差异.小儿死亡风险评分(PRISM)等普适评分应用面相对广,但先心病针对性不强.而特异性评分指标特异性强、评估节力.小儿先心病术后危重程度评分的区分能力优于普适评分(AUC>0.75).第三代小儿死亡风险评分(PRISMⅢ)、第二代小儿死亡指数(PIM2)、小儿先心病术后危重程度评分的校准能力较好(P>0.05).结论:相比普适评分,特异性评分应用于先心病患儿具有一定优势,但仍需深入研究.护理人员在使用工具前应当根据临床情境合理选择符合患儿特点的工具,以提高评估准确性和科学性.