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Abstract：
To integrate intrinsic surgical risk into the paediatric preoperative risk prediction score (PRPS) model to construct a more comprehensive risk scoring system (modified PRPS) and improve the prediction accuracy of postoperative intensive care unit (ICU) admission in paediatric patients.
This was a retrospective study conducted between 1 January and 30 December 2016. Data on age, American Society of Anaesthesiology physical status (ASA-PS), oxygen saturation, prematurity, non-fasted status, severity of surgery and immediate transfer to the ICU after surgery were collected. The modified PRPS was developed by logistic regression in the derivation cohort; it was tested and compared with the paediatric PRPS and ASA-PS by the Hosmer-Lemeshow test, the receiver operating characteristic (ROC) curve and Kappa analysis in the validation cohort.
Hospital-based study in China.
Paediatric patients (≤14 years) who underwent surgery under general anaesthesia were included, and those who needed reoperation due to surgical complications or stayed in the ICU preoperatively were excluded.
ICU admission rate, defined as any patients\' direct disposition from the operating room to the ICU immediately after the surgery.
A total of 9261 paediatric patients were included in this study, with 418 patients admitted to the ICU. In the validation cohort, the modified PRPS model fit the test data well (deciles of risk goodness-of-fit χ2=6.84, p=0.077). The area under the ROC curve of the modified PRPS, paediatric PRPS and ASA-PS were 0.963, 0.941 and 0.870, respectively (p<0.05), and the Kappa values were 0.620, 0.286 and 0.267. Analyses in the cohort indicated that the modified PRPS was superior to the paediatric PRPS and ASA-PS.
The modified PRPS integrating intrinsic surgical risk shows better prediction accuracy than the previous PRPS.
This was a retrospective study conducted between 1 January and 30 December 2016. Data on age, American Society of Anaesthesiology physical status (ASA-PS), oxygen saturation, prematurity, non-fasted status, severity of surgery and immediate transfer to the ICU after surgery were collected. The modified PRPS was developed by logistic regression in the derivation cohort; it was tested and compared with the paediatric PRPS and ASA-PS by the Hosmer-Lemeshow test, the receiver operating characteristic (ROC) curve and Kappa analysis in the validation cohort.
Hospital-based study in China.
Paediatric patients (≤14 years) who underwent surgery under general anaesthesia were included, and those who needed reoperation due to surgical complications or stayed in the ICU preoperatively were excluded.
ICU admission rate, defined as any patients\' direct disposition from the operating room to the ICU immediately after the surgery.
A total of 9261 paediatric patients were included in this study, with 418 patients admitted to the ICU. In the validation cohort, the modified PRPS model fit the test data well (deciles of risk goodness-of-fit χ2=6.84, p=0.077). The area under the ROC curve of the modified PRPS, paediatric PRPS and ASA-PS were 0.963, 0.941 and 0.870, respectively (p<0.05), and the Kappa values were 0.620, 0.286 and 0.267. Analyses in the cohort indicated that the modified PRPS was superior to the paediatric PRPS and ASA-PS.
The modified PRPS integrating intrinsic surgical risk shows better prediction accuracy than the previous PRPS.
摘要：
将内在手术风险纳入儿科术前风险预测评分(PRPS)模型,构建更全面的风险评分系统(改良PRPS),提高儿科患者术后重症监护病房(ICU)入院的预测准确性。
这是一项于2016年1月1日至12月30日进行的回顾性研究。年龄数据,美国麻醉学学会身体状况（ASA-PS），氧饱和度,早产,非禁食状态，收集手术的严重程度和手术后立即转移到ICU.在推导队列中通过逻辑回归开发了改良的PRPS；通过Hosmer-Lemeshow检验对其进行了测试并与儿科PRPS和ASA-PS进行了比较，验证队列中的受试者工作特征(ROC)曲线和Kappa分析。
中国以医院为基础的研究。
包括在全身麻醉下接受手术的儿科患者（≤14岁），而因手术并发症需要再次手术或术前留在ICU的患者被排除在外.
ICU入院率，定义为任何患者在手术后立即从手术室直接处置到ICU。
本研究共纳入9261名儿科患者，418名患者入住ICU。在验证队列中，改进的PRPS模型与测试数据拟合良好(风险拟合优度χ2=6.84,p=0.077)。改良PRPS的ROC曲线下面积,儿科PRPS和ASA-PS分别为0.963、0.941和0.870（p<0.05），Kappa值分别为0.620、0.286和0.267。队列中的分析表明，改良的PRPS优于儿科PRPS和ASA-PS。
整合内在手术风险的改良PRPS比以前的PRPS显示出更好的预测准确性。
这是一项于2016年1月1日至12月30日进行的回顾性研究。年龄数据,美国麻醉学学会身体状况（ASA-PS），氧饱和度,早产,非禁食状态，收集手术的严重程度和手术后立即转移到ICU.在推导队列中通过逻辑回归开发了改良的PRPS；通过Hosmer-Lemeshow检验对其进行了测试并与儿科PRPS和ASA-PS进行了比较，验证队列中的受试者工作特征(ROC)曲线和Kappa分析。
中国以医院为基础的研究。
包括在全身麻醉下接受手术的儿科患者（≤14岁），而因手术并发症需要再次手术或术前留在ICU的患者被排除在外.
ICU入院率，定义为任何患者在手术后立即从手术室直接处置到ICU。
本研究共纳入9261名儿科患者，418名患者入住ICU。在验证队列中，改进的PRPS模型与测试数据拟合良好(风险拟合优度χ2=6.84,p=0.077)。改良PRPS的ROC曲线下面积,儿科PRPS和ASA-PS分别为0.963、0.941和0.870（p<0.05），Kappa值分别为0.620、0.286和0.267。队列中的分析表明，改良的PRPS优于儿科PRPS和ASA-PS。
整合内在手术风险的改良PRPS比以前的PRPS显示出更好的预测准确性。
