儿童早期预警评分在识别危重患儿病情中的价值

Value of Pediatric Early Warning Score in identifying the condition of critically ill children

摘要:

目的 探讨儿童早期预警评分（PEWS）识别危重患儿病情的价值。方法 选取2016年1~12月由中南大学湘雅医院普通病区转入PICU或急诊收入PICU的患儿120例为PICU组，该院该期间入住普通病房的120例患儿作为对照组。对PICU组的120例患儿根据病种的不同分为呼吸/循环系统疾病亚组（55例）和神经/其他系统疾病亚组（65例）。记录患儿入院时的PEWS评分，采用受试者工作特征（ROC）曲线分析PEWS评分对病情评估的价值。结果 PICU组PEWS评分显著高于对照组（P < 0.05）。呼吸/循环系统疾病亚组的PEWS评分显著高于神经/其他系统疾病亚组（P < 0.05）。以患儿是否收住PICU为预测指标时，PEWS评分的最佳截断值为3.5分，灵敏度为85%，特异度为95%，ROC曲线下面积为0.951（95% CI：0.923~0.980）。其中神经/其他系统疾病亚组的患儿ROC曲线下面积为0.768，呼吸/循环系统疾病亚组的患儿ROC曲线下面积为0.968。PEWS评分 > 6分、4~6分及 ≤ 3分患儿的病死率分别为40%、21%、0，组间比较差异有统计学意义（P < 0.001）。结论 PEWS对识别危重症患儿病情严重程度有重要价值，且不同病种对PEWS评分的敏感性有差异；PEWS评分对患儿的预后有预测价值。

Abstract:

Objective To study the value of Pediatric Early Warning Score (PEWS) in identifying the condition of critically ill children.Methods A total of 120 children who were transferred to the pediatric intensive care unit (PICU) from the general ward during hospitalization or admitted to the PICU after emergency treatment in the Xiangya Hospital of Central South University from January to December, 2016 were enrolled as the PICU group. The other 120 children who were admitted to the general ward in the hospital were used as the control group. According to the disease type, the PICU group was further divided into two subgroups:respiratory/circulatory system diseases (n=55) and nervous/other system diseases (n=65). The PEWS score on admission was recorded, and the receiver operating characteristic (ROC) curve was used to analyze the value of PEWS in evaluating patients' condition.Results The PICU group had a significantly higher PEWS score than the control group (P < 0.05). The respiratory/circulatory system disease subgroup had a significantly higher PEWS score than the nervous/other system disease subgroup (P < 0.05). In predicting whether the child was admitted to the PICU, PEWS had a sensitivity of 85%, a specificity of 95%, and an area under the ROC curve (AUC) of 0.951 (95% confidence interval:0.923-0.980) at the optimal cut-off value of 3.5 (PEWS score). The AUC of PEWS was 0.768 in the nervous/other system disease subgroup and 0.968 in the respiratory/circulatory system disease subgroup. The mortality rate of children with a PEWS score of > 6, 4-6 and ≤ 3 was 40%, 21% and 0 respectively (P < 0.001).Conclusions PEWS can well identify disease severity in critically ill children, and it has different sensitivities in children with different varieties of diseases. PEWS has a good value in predicting children's prognosis.