소아 낙상위험 측정도구 (Humpty Dumpty Falls Scale) 평가: 전자의무기록을 이용하여
Evaluation of the Humpty Dumpty Falls Scale: An Analysis of Electronic Medical Records
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초록
연구 목적: 이 연구의 목적은 소아 낙상위험 측정 도구 중 하나 인 Humpty Dumpty Falls Scale의 효율성과, 낙상 예측 인자로서 위험 요소를 평가하는 것이다. 연구 방법: 전자 의무 기록을 이용한 후향적, 환자-대조군 연구 설계이며, 전체 연구 대상은 낙상을 경험한 13명과 낙상 경험이 없는 1941명의 소아 환자이다. 성별, 연령, 진단명, 재원 기간을 기준으로 낙상군에 매칭했을 때 비 낙상군은 429명이었다. 연구 결과: 매칭 후 낙상과 비낙상군 간의 모든 변수는 유의 한 차이가 없었다. Cutoff score 13점에서 민감도, 특이도, 음성 및 양성 예측도는 각각 92.3 %, 37.1 %, 99.9 % 및 0.01 %이었다. ROC 곡선 하 면적은 0.597이었다. 로지스틱 회귀 분석 결과 낙상 위험 점수가 높은 소아 환자 집단이 낙상과 유의한 관련이 있음을 보여주었다(OR 2.49, 90% CI 1.31-4.71). 결론: 진단 점수를 측정하는 매개 변수 중 하나인 ‘산소화 장애’는 낙상 감소 경향과 관련된 것으로 나타났으나, 다른 매개 변수에 비해 배점이 상대적으로 높다. 따라서 대규모 반복 연구를 통한 평가가 필요할 것으로 사료된다.
Abstract
Purpose: The aim of this study was to evaluate the efficiency of the Humpty Dumpty Falls Scale as one of the falls risk assessment tools, and also to evaluate risk factors as predictors of falls in pediatric patient populations. Methods: In a retrospective, case-control design with data from the electronic medical records of 13 pediatric patients who fell and 1,941 who did not fall before matching and 429 who did not fall after matching by gender, age, diagnosis, and length of stay. Results: All the variables showed no significant differences after matching. At the cutoff score of 13, sensitivity, specificity, negative and positive predictive values were 92.3%, 37.1%, 99.9%, and 0.01%, respectively. The area under the Receiver Operating Characteristics was 0.597. The results from the logistic regression showed that the pediatric inpatient population who had higher risk scores was significantly associated with falls. The odds ratios ranged from 1.31 to 4.71 with 90% confidence interval. Conclusion: The saturation impairments criterion as one of the diagnostic parameter was negatively associated with falls, but the relative risk score was higher than the other criteria. Therefore, it seems that the diagnostic parameter seems to be required to verify results through large sample studies.
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