巴西PICU中儿科风险IV死亡率的表现:一个多中心前性研究
Gustavo Rodrigues-Santos1,2, Arnaldo Prata-Barbosa2,3, Fernanda Lima-Setta2,4
1Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Brazil.
Critical care explorations
|March 28, 2025
概括
儿科风险死亡率 (PRISM) IV评分在巴西儿科重症监护病房中显示出良好的歧视,但校准不佳. 需要进一步的研究,以改善其在各种医疗保健环境中的表现.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 医疗服务研究 医疗服务研究
- 生物统计学 生物统计学
背景情况:
- 儿科风险死亡率 (PRISM) IV评分是用于预测重症儿童死亡率的广泛使用的工具.
- 评估PRISM IV在巴西等各种医疗保健系统中的表现对于其有效应用至关重要.
研究的目的:
- 评估PRISM IV评分在巴西儿科重症监护病房 (PICU) 住院的大量患者队列中的表现.
- 用标准化死亡率 (SMR),接收器操作特征曲线 (AUROC) 下的面积和校准带技术来评估分数的歧视和校准.
主要方法:
- 一项纵向,前性,多中心研究,涉及36个巴西PICU.
- 包括2020年3月至2022年3月期间入院的29天至18岁的12,046名儿童.
- 使用SMR,AUROC (95%CI) 和校准带 (80%和95%CI) 的性能评估.
主要成果:
- 总体观察到的死亡率 (2.1%) 比预测高 (1.56%),SMR为1.32.
- 观察到良好的区分 (AUROC = 0.86),但校准很差,低估了广泛范围 (2-61%) 的死亡率.
- 在COVID-19大流行期间的表现有所不同,在疫苗接种前期的校准较差,在疫苗接种后期的校准有所改善,尽管仍然不完美.
结论:
- 在巴西的PICU中,PRISM IV表现出良好的区分能力,但显著的校准错误.
- 乐谱的表现受到COVID-19大流行的影响,需要针对不同时间阶段进行调整.
- 进一步的研究,包括子组分析,对于提高PRISM IV在巴西异质医疗保健环境中的准确性至关重要.
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