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目的 :比较6项危重程度评估工具应用于先心病术后患儿病情评估中的效果。方法 :比较6项工具内涵并采用t检验、ROC曲线下面积、Hosmer-Lemeshow拟合优度检验等比较工具应用效果。结果 :纳入1 284例患儿,6项工具在构建方式、评分内容、评分应用层面存在差异。小儿死亡风险评分(PRISM)等普适评分应用面相对广,但先心病针对性不强。而特异性评分指标特异性强、评估节力。小儿先心病术后危重程度评分的区分能力优于普适评分(AUC>0.75)。第三代小儿死亡风险评分(PRISMⅢ)、第二代小儿死亡指数(PIM2)、小儿先心病术后危重程度评分的校准能力较好(P>0.05)。结论 :相比普适评分,特异性评分应用于先心病患儿具有一定优势,但仍需深入研究。护理人员在使用工具前应当根据临床情境合理选择符合患儿特点的工具,以提高评估准确性和科学性。
PURPOSE: To compare the effectiveness of six tools for assessing the severity of illness in children with congenital heart disease (CHD). Methods: Comparing the connotation of six tools and using t test, area under ROC curve, Hosmer-Lemeshow goodness-of-fit test and other comparative tools. Results: A total of 1 284 children were enrolled in this study. There were differences in the way of construction, scoring content and grading of 6 tools. Pervasive scores such as the PRISM score were relatively broad, but were less targeted. The specificity of scoring specific indicators, assessment of nodular strength. The discriminatory power of post-operation critically ill children with CHD was superior to the generalized score (AUC> 0.75). PRISMⅢ, PIM2 and CHD scores of children with CHD were better than those of children with CHD (P> 0.05). CONCLUSIONS: Compared with the generalized score, the specific score applied to children with congenital heart disease has certain advantages, but still needs further study. Nurses should be based on the clinical situation before the use of tools to choose a reasonable child-specific tools to improve the accuracy and scientific evaluation.