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Objective:To establish a mortality risk prediction model of severe bacterial infection in children and compare it with the pediatric early warning score (PEWS), pediatric critical illness score (PCIS) and pediatric risk of mortality score Ⅲ (PRISM Ⅲ).Methods:A total of 178 critically ill children were selected from the PICU of the Children's Hospital of Nanjing Medical University from May 2017 to June 2022. After obtaining the informed consent of the parents/guardians, basic information such as sex, age, height and weight, as well as indicators such as heart rate, systolic blood pressure and respiratory rate were collected from all children. A standard questionnaire was used to score the child 24 h after admission to the PICU. The children were divided into the survival and death groups according to their survival status at 28 d after admission. A mortality risk prediction model was constructed and nomogram was drawn. The value of the mortality risk prediction model, PEWS, PCIS and PRISM in predicting the risk of death was assessed and compared using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC).Results:Among the 178 critically ill children, 11 cases were excluded due to severe data deficiencies and hospitalization not exceeding 24 h. A total of 167 children were included in the analysis, including 134 in the survival group and 33 in the death group. A mortality risk prediction model for children with severe bacterial infection was constructed using pupillary changes, state of consciousness, skin color, mechanical ventilation, total cholesterol and prothrombin time. ROC curve analysis showed that the AUCs of mortality risk prediction model was 0.888 ( P<0.05). The AUCs of PEWS, PCIS and PRISM Ⅲ in predicting death in children with severe bacterial infection were 0.769 ( P< 0.05), 0.575 ( P< 0.05) and 0.759 ( P< 0.05), respectively. Hosmer-Lemeshow goodness-of-fit test showed the best agreement between risk of death and PEWS predicted morbidity and mortality and actual morbidity and mortality (χ 2 = 5.180, P = 0.738; χ 2 = 4.939, P = 0.764), and the PCIS and PRISM Ⅲ predicted mortality rates fitted reasonably well with actual mortality rates (χ 2= 9.110, P= 0333; χ 2 = 8.943, P= 0.347). Conclusions:The mortality risk prediction model for predicting the death risk has better prognostic value than PEWS, PCIS and PRISM Ⅲ for children with severe bacterial infection.
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BACKGROUND: Although the Incidence of irritation, abrasion and rupture of the extensor tendon at the dorsal carpal side of the distal radius caused by internal fixation with volar locking plate is not high, these complications seriously affect the quality of life of the patients. OBJECTIVE: To summarize the latest progress of intraoperative fluoroscopy in the treatment of distal radius fracture with volar locking plate. METHODS: Using the English key words "volar locking plate, distal radius fracture, radiological method", the authors retrieved PubMed for 160 relevant studies published from 2000 to 2019. Using the Chinese key words "fluoroscopy, distal radius fracture, volar plate", the authors searched Wanfang database for 7 relevant studies published from 2000 to 2019. This paper reviewed the literature of intraoperative fluoroscopy in the treatment of distal radius fracture with volar locking plate. RESULTS AND CONCLUSION: (1) There are various methods of intraoperative fluoroscopy during volar locking plate fixation for distal radius fracture, such as standard anteroposterior view, lateral view, carpal canal method, skyline, dorsal tangent view and radial groove view. (2) The above common methods still have some limitations in detecting the problem of posterior screw penetration in volar locking plate fixation. The complications such as irritation, abrasion and rupture of the extensor tendon of the dorsal wrist still occur, and the problems brought by the secondary and multiple operations to the patients' life and economy should also be paid attention to. (3) More appropriate intraoperative detection methods should be found, in order to reduce the incidence of complications caused by the internal fixation of the posterior screw with the locking plate on the palmar side.