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首页> 外文期刊>The Internet Journal of Emergency and Intensive Care Medicine >Assessment of survival in a pediatric intensive care unit In lima, peru
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Assessment of survival in a pediatric intensive care unit In lima, peru

机译：秘鲁利马儿童重症监护病房的生存率评估

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Objective: To assess the condition at admission, survival, and prognosis at a paediatric intensive care unit. Design: Longitudinal prospective study. Setting: Paediatric intensive care unit in an institute specializing in treating children. Patients: 819 patients between three and 17.9 years of age admitted consecutively during a 42-month-period. Material and Methods: Paediatric Risk of Mortality, Therapeutic Intervention System Score, and predicted rate of mortality were determined to construct survival tables and curves. Effectiveness was determined by comparing the severity of illness-based predicted mortality rate with the international standard and efficiency by Pollack’s criteria. Results: Overall mortality rate was 16.2% (n = 133). We set the final follow-up time at 30 days of PICU discharge to other services. PRISM score (P = 0.001), time of nurse’s care (P = 0.007), mechanical ventilation (P = 0.001), gender (P = 0.016), primary clinical specialty (P = 0.033), and major diagnostic category (P = 0.035) were associated with mortality. Survival curves for critical diseases showed a similar tendency during the first 10 days. After 10 days, children with non-surgical diseases had a lower probability of survival. Mean scores were: PRISM, 10.8 ± 6.85; paediatric death rate, 8.15 ± 11.94; and TISS-28, 26.4 ± 9.83. Admission efficiency demonstrated that 84.0 % of admissions to the unit were justified. Conclusions: The probability of survival decreased at PICU discharge as length of stay increased. Non-surgical diseases had a lower probability of survival. Trauma patients had greater probability of survival if no surgery was needed. The efficiency at our unit met the standard set forth in American and European studies. Introduction Until the last decade, poor children in Peru had limited or no access to health services. In 1997, the government established a system to deliver free health care to children attending government-run schools (children from private schools were excluded), which covered children from the age of three years until their 18th birthday. This health care system for school children from poor families lasted until January 2001, when a new, more integrated health system was established to cover children of all ages. Our research study was performed in a paediatric intensive care unit (PICU) during the period when health care services were free for poor children from their initial entry to school through secondary school. This study aimed to evaluate if the use of costly critical care to poor children was effective, as measured by outcomes, when compared to patients who were as ill in other developed countries. Intensive care for children has contributed to the marked reduction in the rate of mortality and morbidity for certain diagnostic categories in Peru and in developed countries. Increased demand for health care, new technologies, and awareness of limited resources have become prominent issues, and intensive care paediatricians are interested in new ways to evaluate health care programs1,2,3. This has fostered the need for quantitative methods to evaluate medical activities in the paediatric population. Severity of illness scoring systems in intensive care have been developed and validated for all ages in the United States4,5,6,7, Europe8 and other settings9,10,11, and these systems have been improved and simplified12,13. Very few studies using these severity of illness scoring systems have been carried out in Latin American countries14,15,16,17,18.When PICU was not available at our institution mortality was over 50 %. After establishing the necessity of intensive care and demonstrating that mortality could be lowered with skills, procedures and technologies proven in developed countries, paediatric mortality progressively decreased in our institution and in our country. However, we also saw that inadequate care could result in varying degrees of morbidity without necessarily resulting in death. In infants
机译：目的：评估小儿重症监护病房的入院，生存和预后状况。设计：纵向前瞻性研究。地点：专门治疗儿童的研究所中的儿科重症监护室。患者：在42个月内连续收治819位3至17.9岁的患者。材料和方法：确定儿童死亡风险，治疗干预系统评分和预测死亡率，以构建生存表和曲线。通过将基于疾病的预测死亡率的严重程度与国际标准进行比较，并根据Pollack的标准对效率进行评估，从而确定有效性。结果：总死亡率为16.2％（n = 133）。我们将最终随访时间定为将PICU释放至其他服务的30天。 PRISM评分（P = 0.001），护理时间（P = 0.007），机械通气（P = 0.001），性别（P = 0.016），主要临床专业（P = 0.033）和主要诊断类别（P = 0.035） ）与死亡率有关。关键疾病的生存曲线在前10天中显示出相似的趋势。 10天后，患有非手术疾病的儿童存活的可能性较低。平均得分为：PRISM，10.8±6.85;小儿死亡率，8.15±11.94;和TISS-28，26.4±9.83。录取效率表明，该单元录取的84.0％是合理的。结论：随着住院时间的延长，PICU出院后存活的可能性降低。非手术疾病的存活率较低。如果不需要手术，创伤患者的生存可能性更大。我们单位的效率达到了美国和欧洲研究制定的标准。引言直到最近十年，秘鲁的贫困儿童获得保健服务的机会有限或根本没有。 1997年，政府建立了向在国营学校就读的儿童（不包括私立学校的儿童）提供免费医疗服务的系统，该系统覆盖了3岁至18岁生日的儿童。这种针对贫困家庭学童的医疗保健制度一直持续到2001年1月，当时建立了一个新的，更加综合的保健制度，以覆盖所有年龄段的儿童。我们的研究是在儿童重症监护室（PICU）进行的，在这段时期内，贫困儿童从初次上学到中学都免费获得医疗服务。这项研究旨在评估与其他发达国家患病患者相比，按结果衡量的对贫困儿童使用昂贵的重症监护是否有效。在秘鲁和发达国家，对儿童的重症监护显着降低了某些诊断类别的死亡率和发病率。对医疗保健，新技术的需求增加以及对有限资源的认识已成为突出的问题，重症监护儿科医生对评估医疗保健计划的新方法1,2、3感兴趣。这促使人们需要一种定量方法来评估儿科人群的医疗活动。在美国4、5、6、7，欧洲8和其他地区9、10、11，已经开发并验证了重症监护病情严重度评分系统，适用于所有年龄段。这些系统已得到改进和简化12、13。在拉丁美洲国家中，很少有使用这些疾病严重程度评分系统的研究14、15、16、17、18。在我们机构无法获得PICU时，死亡率超过50％。在确定了重症监护的必要性并证明可以通过发达国家证明的技能，程序和技术降低死亡率后，我们机构和我国的儿科死亡率逐渐降低。但是，我们还看到，护理不足可能会导致不同程度的发病，而不一定导致死亡。在婴儿中

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