儿科急诊室陈述中的死亡率预测因素:系统性审查和元分析
Mohammed Alsabri1,2, Mohamed A ELKarargy3, Israa Magdy Ata4
1Emergency Department, Althawara Modern General Hospital, Sanaa, Yemen. Alsabri5000@gmail.com.
BMC emergency medicine
|September 27, 2025
概括
儿科早期预警评分 (PEWS) 有效地识别低风险儿科患者,但临床判断对于准确评估急诊室高风险病例至关重要.
科学领域:
- 儿科急救医学 儿科急救医学
- 临床风险评估临床风险评估
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在急诊室 (ED) 的儿科患者表现出不同的临床表现,需要系统地评估恶化的风险.
- 儿科急诊室 (PED) 现有的死亡预测指标的预测准确性需要进行彻底的评估.
研究的目的:
- 评估PED中各种死亡预测指标的诊断准确性.
- 评估这些预测因素的度量,包括这些预测因素的灵敏度,特异性和诊断几率比率.
主要方法:
- 对2000-2024年期间的队列研究,病例控制研究和RCT进行了多个数据库的系统搜索.
- 研究包括儿科患者 (0-18岁) 呈现PEDs,分析在ED和短期后ED死亡率的死亡率预测因素.
- 使用双变随机效应建模来计算聚合的灵敏度,特异性,DOR和AUC.
主要成果:
- 对329个儿科早期预警分数 (PEWS) 值的分析显示,最佳切割值为2.189 (AUC=0.70),聚合灵敏度高 (0.95) 和特异性高 (0.93).
- 观察到强烈的负预测值 (NPV=0.0006) 和适度的正预测值 (PPV=0.0003).
- 发现了显著的异质性 (I2>99%),受PEWS版本和设置的影响;然而,PEWS的实施降低了死亡率,但在资源有限的环境中没有增加ICU入院.
结论:
- 儿科早期预警评分 (PEWS) 作为一种有效的工具,用于排除低风险儿科患者.
- 综合临床判断的综合方法对于高风险儿科患者的准确风险评估至关重要.
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