Введение

rosped

Российский педиатрический журнал имени М.Я. Студеникина

M.Ya. Studenikin Russian Pediatric Journal

ФГАУ «НМИЦ здоровья детей» Минздрава России

10.46563/1560-9561-2023-26-6-443-449

vhlmoo

rosped-385

Research Article

ОБЗОРЫ

REVIEWS

Современные шкалы рисков в педиатрии и детской кардиохирургии как инструменты оценки качества медицинской помощи

Modern risk scales in pediatrics and pediatric cardiac surgery as tools for assessing the quality of medical care

https://orcid.org/0000-0002-7512-3991

Сарсенбаева

Гульжан Искендировна

Sarsenbaeva

Gulzhan I.

Канд. мед. наук, кардиохирург, «Научный центр педиатрии и детской хирургии» Минздрава Республики Казахстан

e-mail: gulzhan75@mail.ru

MD, PhD, Scientific Center of Pediatrics and Pediatric Surgery, Almaty, 050044, Republic of Kazakhstan

e-mail: gulzhan75@mail.ru

gulzhan75@mail.ru

Научный центр педиатрии и детской хирургии Минздрава Республики КазахстанScientific Center of Pediatrics and Pediatric Surgery

2023

06012024

266443449

2024

Сарсенбаева Г.И.

Sarsenbaeva G.I.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.rosped.ru/jour/article/view/385

Введение

Введение. В обзоре представлены характеристики современных шкал рисков в педиатрии. Проведён сравнительный анализ преимуществ и недостатков шкал рисков в детской кардиохирургии. Показано, что раннее выявление пациентов высокого риска является основой профилактики неблагоприятных исходов после кардиохирургических операций. Установлены возможности базовой шкалы Аристотеля (Aristotle Basic Complexity Score — ABC) как инструмента оценки качества хирургического лечения детей с врождёнными пороками сердца. Её детерминантами являются летальность, сложность послеоперационного периода, техническая сложность операции. Оценивали корреляцию между значениями шкалы ABC и её детерминантами. Если значения всех детерминант превышали верхний предел 95% доверительного интервала, пациента включали в группу высокого риска. Качество лечения оценивали по индексу производительности. Выявлена тесная корреляция между ABC и её детерминантами. Для шкалы ABC установлена высокая точность прогноза летального исхода, осложнений и технической сложности с оптимальным пороговым значением 6,5 балла. У пациентов с ABC выше порогового значения была большая вероятность смерти. Индекс производительности составил 0,56, аналогичные показатели зарубежных клиник — 0,46–0,62 балла.

Заключение

Заключение. ABC и новые шкалы стратификации рисков после кардиохирургических операций у детей являются эффективными системами оценки результатов хирургического лечения пациентов с врождёнными пороками сердца разного уровня сложности, могут использоваться для определения качества хирургического лечения и выявления групп высокого риска.

Финансирование

Финансирование. Исследование не имело финансовой поддержки.

Конфликт интересов

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Поступила 20

Поступила 20.10.2023Принята к печати 28.11.2023Опубликована 27.12.2023

Introduction

Introduction. The review presents the characteristics of modern risk scales in pediatrics. A comparative analysis of the advantages and disadvantages of risk scales in pediatric cardiac surgery has been carried out. Early detection of high-risk patients was shown to be the basis for the prevention of adverse outcomes after cardiac surgery. The capabilities of the Aristotle School (Aristotle Basic Complexity (ABC) Score have been established as a tool for assessing the quality of surgical treatment of children with congenital heart defects (CHD). Its determinants are mortality, the complexity of the postoperative period, and the technical complexity of the operation. The correlation between the values of the ABC scale and its determinants was evaluated. If the values of all three determinants exceeded the upper limit of the 95% confidence interval (CI), the patient was included in the high-risk group. The quality of treatment was assessed by the performance index (IP). A close correlation between ABC and its determinants has been revealed. For the ABC school, a high accuracy of the prognosis of death, complications, and technical complexity was established with an optimal threshold value of 6.5 points. Patients with ABC above the threshold were more likely to die. The IP was 0.56, similar indicators of foreign clinics ranged from 0.46 to 0.62 points.

Conclusion

Conclusion. The basic Aristotle scale and new risk stratification scales after cardiac surgery in children are effective systems for evaluating the results of surgical treatment of CHD patients of different levels of complexity can be used to determine the quality of surgical treatment and identify high-risk groups.

Acknowledgment

Acknowledgment. The study had no sponsorship.

Conflict of interest

Conflict of interest. The author declares no conflict of interest.

Received

Received: October 20, 2023Accepted: November 28, 2023Published: December 27, 2023

обзорврождённые пороки сердцадетская кардиохирургиястратификация рисковшкала Аристотеля

reviewcongenital heart defectspediatric cardiac surgeryrisk stratificationAristotle scale

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The authors declare that there are no conflicts of interest present.