摘要目的 探讨儿童早期预警评分(PEWS评分)用于住院呼吸系统疾病患者病情判断的有效性.方法 选取2012年10月至2013年10月广州市妇女儿童医疗中心呼吸科住院期间因病情加重需要转入ICU治疗的患者36例,取同时入院但不需要转ICU治疗的377例作为对照,总病例413例.按照病情严重程度分为3个组:(1)非监护组302例(对照);(2)监护组75例(对照);(3)ICU组36例(病例).记录非监护组、监护组入院时的PEWS评分,ICU组转入ICU 12 h前的PEWS评分.比较各组PEWS评分的差异,并行受试者工作特征曲线(ROC)分析.结果 3组患者的年龄中位数(四分位数间距)分别是ICU组10个月(4～13个月),监护组10个月(6 ～16个月),非监护组14个月(6～24个月),3组间差异具有统计学意义(H=13.59,P＜0.01).3组患者PEWS评分中位数(四分位数间距)分别是ICU组6分(6～7分),监护组5分(4～5分),非监护组2分(1～2分),3组间差异具有统计学意义(x2 =255.641,P＜0.01).患者需要增加监护的PEWS评分为3.5分,ROC曲线下面积为0.898,95％CI:0.867 ～0.929,敏感度为0.907,特异度为0.893;患者需要转入ICU的PEWS评分为4.5分,ROC曲线下面积0.978,95％ CI:0.964 ～0.992,敏感度为1.000,特异度为0.862.结论 PEWS评分可以用于呼吸系统疾病住院患者病情严重程度判断和转入ICU的预测.

abstractsObjective To validate the efficacy of Pediatric Early Warning Score (PEWS) in severity evaluation of respiratory inpatients.Methods Four hundred and thirteen children with respiratory disease were hospitalized in Pneumology Department of Guangzhou Women and Children's Medical Centre from October 2012 to October 2013,of which 36 cases required Intensive Care Unit (ICU) treatment while the rest 377 controls did not.According to the disease severity,cases and controls were further categorized into 3 groups:no-monitor-required group (n =302,controls),monitor-required group (n =75,controls),ICU group (n =36).PEWS was assessed at admission in controls and 12 hours before ICU transfer,respectively.PEWS were compared among all groups and receiver operator characteristic curve(ROC) was performed.Results The median [interquartile rang(IQR)] age in ICU group was 10 months(4-13 months),monitor-required group was 10 months (6-16 months),and no-monitor-required group was 14months(6-24 months),and the difference was significant (H =13.59,P ＜ 0.01).The median (IQR) of PEWS in ICU group was 6 scores (6-7 scores),monitor-required groups was 5 scores (4-5 scores),on-monitor-required group was 2 scores (1-2 scores),and the difference was significant (x2 =255.641,P ＜ 0.01).PEWS in monitor required group and ICU group was 3.5 score with area under ROC (AUC) as 0.898 (95％ CI:0.867-0.929,sensitivity0.907,specificity 0.893) and 4.5 with AUC as 0.978 (95％ CI:0.964-0.992,sensitivity 1.000,specificity 0.862),respectively.Conclusions PEWS can be indicative for severity classification in hospitalized respiratory pediatric patients,and can serve as a potentially excellent screening tool for prediction of ICU admission.