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Emergency transport of critically ill neonates is an important means to reduce neonatal mortality and improve prognosis.Neonatal transport score is used to evaluate the safety of transport, mainly including transport risk index of physiologic stability, mortality index for neonatal transportation, transport related mortality score and intrauterine transport score.Evaluating the severity of disease of critically ill newborns before, during and after transport can reduce the occurrence of transport complications, reduce neonatal mortality, improve prognosis and increase the success rate of treatment.This paper reviews the research progress of critical neonatal transport scoring at home and abroad to help clinicians choose appropriate scoring methods according to specific conditions, in order to provide a basis for continuous quality improvement in this field.
ABSTRACT
Abstract Background: Multiple risk scores (RS) are approved in the prediction of worse prognosis in acute coronary syndromes (ACS). Recently, the Portuguese Journal of Cardiology has proposed the ProACS RS. Objective: Application of several validated RS, as well as ProACS in patients, admitted for ACS. Evaluation of each RS's performance in predicting in-hospital mortality and the occurrence of all-cause mortality or non-fatal ACS at one-year follow-up and compare them to the ProACS RS. Methods: A retrospective study of ACS was performed. The following RS were applied: GRACE, ACTION Registry-GWTG, PURSUIT, TIMI, EMMACE, SRI, CHA2DS2-VASc-HS, C-ACS and ProACS. ROC Curves were created to determine the predictive power for each RS and then were directly compared to ProACS. Results: The ProACS, ACTION Registry-GWTG and GRACE showed a c-statistics of 0.908, 0.904 and 0.890 for predicting in-hospital mortality, respectively, performing better in ST-segment elevation myocardial infarction patients. The other RS performed satisfactorily, with c-statistics over 0.750, apart from the CHA2DS2-VASc-HS and C-ACS which underperformed. All RS underperformed in predicting worse long-term prognosis revealing c-statistics under 0.700. Conclusion: ProACS is an easily obtained risk score for early stratification of in-hospital mortality. When evaluating all RS, the ProACS, ACTION Registry-GWTG and GRACE RS showed the best performance, demonstrating high capability of predicting a worse prognosis. ProACS was able to demonstrate statistically significant superiority when compared to almost all RS. Thus, the ProACS has showed that it is able to combine simplicity in the calculation of the score with good performance in predicting a worse prognosis.
Resumo Fundamento: Existem muitos escores de risco (ERs) aprovados na predição de um pior prognóstico em síndromes coronárias agudas (SCAs). Recentemente, a Revista Portuguesa de Cardiologia propôs o ER ProACS. Objetivo: Aplicar vários ERs validados, bem como o ProACS em pacientes internados por SCA. Avaliar o desempenho de cada ER em predizer mortalidade hospitalar e a ocorrência de mortalidade por todas as causas ou SCA não fatal em um ano de acompanhamento e compará-los com o ProACS. Métodos: Estudo retrospectivo de SCA. Os seguintes ERs foram aplicados: GRACE, ACTION Registry-GWTG, PURSUIT, TIMI, EMMACE, SRI, CHA2DS2-VASc-HS, C-ACS e ProACS. Curvas ROC foram criadas para determinar o poder preditivo de cada ER e diretamente comparadas com a do ProACS. Resultados: Os escores ProACS, ACTION Registry-GWTG e GRACE mostraram estatística-C de 0,908, 0,904 e 0,890, respectivamente, em predizer mortalidade hospitalar, mostrando melhor desempenho em pacientes com infarto do miocárdio com elevação do segmento ST. Os demais ERs mostraram desempenho satisfatório, com estatística-C acima de 0,750, com exceção de CHA2DS2-VASc-HS e C-ACS, que mostraram baixa performance. Todos os ERs apresentaram baixo desempenho em predizer um pior prognóstico em longo prazo, com estatística-C abaixo de 0,700. Conclusão: O ProACS é um escore de risco facilmente obtido para estratificação precoce de mortalidade intra-hospitalar. Ao avaliar todos os ERs, ProACS, ACTION Registry-GWTG e GRACE mostraram o melhor desempenho, com alta capacidade de predizer um pior prognóstico. O ProACS mostrou superioridade estatisticamente significativa em comparação aos outros ERs. Portanto, o ProACS mostrou-se capaz de combinar simplicidade no cálculo do escore com bom desempenho em predizer um pior prognóstico.
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Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Acute Coronary Syndrome/mortality , Prognosis , Risk Factors , ROC Curve , Hospital Mortality , Risk Assessment , Acute Coronary Syndrome/diagnosisABSTRACT
Objective To compare the value of three neonatal referal scoring systems in predicting the risk of mortality in preterm and low birth weight infants. Methods Six hundred and fourty-nine prema-ture neonates-fetal age <37 weeks and birth weight <2 500g infants were transported to the neonatal inten-sive care unit of Hunan Children′s Hospital from January 1 to December 31,2016. The score of transport risk index of physiologic stability(TRIPS),mortality index for neonatal transportation(MINT)score and transport related mortality score(TREMS)were conducted for them. Results TRIPS,MINT and TREMS scoring sys-tems of the death group were significantly higher than those of the survival group(P<0. 001). In the multi-variate Logistic regression analysis,systolic blood pressure,reaction of foot hit and the intubation of respirato-ry in the TRIPS entered the regression equation. The birth weight,blood pH value and whether intubation when contacted in the MINT score were included in the equation. Hypotension,hypoxemia and hypercapnia of TREMS were entered the regression equation,indicating these factors were the independent risk factors for death in preterm and low birth weight infants. The area under the receiver operating characteristic and 95%CI of TRIPS,MINT and TREMS were 0. 843(0. 796,0. 889),0. 796(0. 722,0. 871)and 0. 712(0. 639,0. 786), respectively. Conclusion The TRIPS is more accurate than MINT and TREMS in predicting the risk of ref-erral mortality in referaling preterm and low birth weight infants.