一个标准化的评分系统来预测不必要的转移到儿童医院尾炎评估
Ashlyn Morgan White1, Sydney Morris1, McKenzie Montana2
1Department of Surgery, University of South Carolina School of Medicine Greenville, Greenville, SC, USA.
The American surgeon
|April 28, 2025
概括
一个新的评分系统可以识别不需要住院转院的儿科尾炎患者. 该工具通过有效查患者,有助于减少不必要的转移和医疗保健成本.
科学领域:
- 儿科急救医学 儿科急救医学
- 临床决策支持系统 临床决策支持系统
- 医疗保健资源管理 医疗保健资源管理
背景情况:
- 急性尾炎是一种常见的儿科疾病,导致频繁的医院间转移.
- 转移的儿科尾炎患者经常接受过度的诊断测试,增加成本而没有更高的并发症率.
- 目前,没有经过验证的评分系统可以预测哪些疑似尾炎的儿科患者不需要转移到专门的儿童医院.
研究的目的:
- 开发和验证一个预测评分系统,用于识别疑似尾炎的儿科患者,不需要医院间转移.
- 为了减少不必要的转移,并优化资源利用在儿科尾炎护理.
- 为管理儿科尾炎评估的急诊室提供实用的查工具.
主要方法:
- 对1354名儿科患者 (5-17岁) 的回顾性审查,这些患者在五年内被转移用于尾炎评估.
- 使用导数集 (n=1099) 开发后勤回归模型,并在单独的集 (n=215) 上进行验证.
- 对人口统计,症状,生命体征和实验室结果进行分析,以确定尾炎的预测因素,根据几率比率分配权重.
主要成果:
- 总共有439名 (33.4%) 转移患者被诊断患有尾炎.
- 尾炎的关键预测因素包括年龄≥10岁,男性性别,西班牙裔种族,恶心,吐,绝对中性粒细胞数量高,淋巴细胞百分比低.
- 具有≤5分值的评分系统在预测不需要转移的患者方面表现出高准确度 (AUC 0.802/0.772),达到90%的灵敏度和90.9%的负预测值.
结论:
- 大多数为尾炎评估转移的儿科患者没有这种情况.
- 开发的评分系统有效地识别了不太可能患上尾炎的儿童,从而避免了不必要的医院间转移.
- 该工具的实施可能会导致医疗保健成本大幅降低和资源分配不适当.
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