儿童早期预警评分在识别手足口病危重症中的应用
摘要
目的:探讨儿童早期预警评分(PEWS)在识别手足口病危重症中的应用效果。方法:对青岛市某三级甲等儿童医院2014年1月～2016年12月住院治疗的2498例手足口病重症患儿进行回顾性分析,根据病例记录生命体征监测值进行PEWS,构建ROC曲线,分析PEWS对手足口病危重症患儿病情的预警作用。结果:以患儿是否入住PICU为区别重症与危重症的指标,计算PEWS在手足口病危重症预警中的最佳截断值为2. 5分,约登指数最大为0. 308时,敏感度为0. 635,特异性为0. 673,ROC曲线下面积(AUC)为0. 674(95%CI:0. 640～0. 707)。结论:PEWS可以用于手足口病危重症病情发展的早期预警,但敏感度和特异性均不高,针对手足口病危重症患儿的预警评分系统需要改良,以更好地满足临床工作需要。
引文
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[2] Monaghan A. Detecting and managing deterioration in chil-dren[J]. Paediatric Nursing,2005,17(1):32-35.
[3] SM Skaletzky,A Raszynski,BR Totapally. Validation of amodified pediatric early warning system score:a retrospec-tive case control study[J]. Clinical Pediatric,2012,51(5):431-435.
[4]李兴旺,钱素云,陈强,等.手足口病诊疗指南(2018版)[J].中华传染病杂志,2018,36(5):257-263.
[5]王卫平,孙锟,常立文.儿科学[M].北京:人民卫生出版社,2018:7.
[6]孙倩莱,高立冬,等. 2009-2015年湖南省手足口病死亡率例临床与流行病学特征分析[J].实用预防医学,2017,24(2):148-151.
[7]潘玉勤,梁丽萍,叶秋喜,等.前瞻性管理在重症手足口病护理中的效果分析[J].中国医学创新,2014,11(10):102-104.
[8] Niu X,Tilford B,Duffy E,et al. Feasibility and reliability ofpediatric early warning score in the emergency department[J]. J Nurs Care Qual,2016,31(2):161-166.
[9] Chaiyakulsil C,Pandee U. Validation of pediatric early warn-ing score in pediatric emergency department[J]. Pediatr Int,2015,57(4):694-698.
[10] Tucker KM,Brewer TL,Baker RB,et al. Prospective evalua-tion of a pediatric inpatient early warning scoring system[J]. J Spec Pediatr Nurs,2009,14:79-85.
[11] Agulnik A,Forbes PW,Stenquist N,et al. Validation of ped-iatric early warning score in hospitalized pediatric oncologyand hematopoietic stem cell transplant patients[J]. Pediat-ric Crit Med,2016,17(4):146-153.
[12] Dean NP,Fenix JB,Spaeder M,et al. Evaluation of pediatricearly warning score across different subspecialty patients[J]. Pediatric Crit Care Med,2017,18(7):655-660.
[13]戴桂凤.儿童早期预警评分在门诊手足口病患儿分流及病情评估中的应用[J].医学理论与实践,2017,30(13):1897-1899.
[14] Aker M,Finkelstein M,Erickson M,et al. Sensitivity of thepediatric early warning score to identify patient deterioration[J]. Pediatric,2010,125(6):763-769.
[15] Breslin K,Marx J,Hoffman H,et al. Pediatric early warningscore at time of emergency department disposition is associ-ated with level of care[J]. Pediatric Emergency Care,2014,30:97-103.
[16]唐慧,杨艳,李映兰,等.儿童早期预警评分在急性淋巴细胞白血病患儿中的应用[J].中华护理杂志,2017,52(12):1422-1426.
[17]林俊宏,谢志伟,何春卉,等.儿童早期预警评分对住院呼吸系统疾病患儿病情判断的有效性[J].中华实用儿科临床杂志,2016,31(16):1235-1237.
[18]蔡群,徐美玉,李斌.儿童早期预警评分在病毒性脑炎中的应用[J].江苏医药,2014,40(1):67-69.
[19] Swets JA. Measuring the accuracy of diagnostic systems[J]. Science,1988,240(4857):1285-1293.
[20] Lu Mei,Xin Song,Yan Kong,et al. An assessment of a ped-iatric early warning system score in severe hand-foot andmouth disease children[J]. Medicine,2018,97:26.