Exame da validade do Nine Equivalents of Nursing Manpower Use Score (NEMS) em uma unidade de terapia intensiva pediátrica

• Autor(a) principal: Canabarro, Simone Travi
• Data de Publicação: 2009
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional PUCRS
• Texto Completo: http://hdl.handle.net/10923/4664
• topic: MEDICINA; PEDIATRIA; UNIDADES DE TERAPIA INTENSIVA PEDIÁTRICA; ENFERMAGEM PEDIÁTRICA; ENFERMAGEM - UNIDADES DE TERAPIA INTENSIVA; PROGNÓSTICO

Introduction The Nine Equivalents of Nursing Manpower Use Score is a score that was developed from the Therapeutic Intervention Scoring System-28 and has also been used to measure nursing staff workload. Originally the Therapeutic Intervention Scoring System was designed to relate itself with the severity levels of hospitalized patients in intensive therapy. Studies have been realized in different countries trying to evaluate and/or to relate the therapeutic indexes from patients critically sick hospitalized in Intensive Care Units, with interventions, prognosis and/or mortality, and to provide comparisons between these Units. Aims To evaluate the Nine Equivalents of Nursing Manpower Use Score (NEMS) and compare with the Therapeutic Intervention Scoring System-28 (TISS-28) in children. Methods This was a prospective observational study realized between 10/01/2006 and 09/30/2008 in a Pediatric Intensive Care Unit (ICU). Data from all patients admitted to the Pediatric ICU were included. Variables from NEMS and TISS-28 were daily registered for each admitted children. Demographic data were also collected. The patients were followed until release from pediatric ICU or death. The variables from NEMS and TISS-28 regarding each child admitted between 12 and 14 pm every 24 hours were registered daily by nurses. Results 816 children were included in this study accounting 7. 702 observations. NEMS scores ranged from 6 to 48 with mean of 24. 7±8. 2 and median of 23 at admission. The maximum NEMS ranged from 6 to 51 with mean of 26. 6±9. 2 and median of 25. TISS-28 score ranged from 6 to 52 with mean of 19. 2±7. 4 and median of 18 at admission. The day with highest score (maximum TISS-28) TISS-28 ranged from 6 to 59 with mean of 21. 3± 8. 2 and median of 23.Considering all observations the TISS-28 average was lower than NEMS (p<0. 001). The observed mortality was 6. 6%. NEMS and TISS-28 showed a good mortality discrimination when performed at admission [area under the ROC curve (AUROC) of 0. 71 (0. 63-0. 78) and 0. 68 (0. 60-0. 75), respectively]; and also the maximum score [AUROC of 0. 80 (0. 74-0. 85) and 0. 76 (0. 70-0. 82), respectively]. ROC correlation between NEMS and TISS-28 was significant (R2=0. 69 for all observations, R2=0. 70 at admission and R2=0. 74 for maximum score, p<0. 01 for all) allowing customization. Conclusions A strong correlation between TISS-28 and NEMS was found in this population of pediatric patients. Both tests proved to be discriminatory for mortality. However NEMS overestimated nursing workload when compared to TISS-28 suggesting that an adjustment is mandatory (customization).