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

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. 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. Исследование не имело финансовой поддержки.

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Поступила 20.10.2023
Принята к печати 28.11.2023
Опубликована 27.12.2023

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