BACKGROUND While the populations of children who can benefit from paediatric palliative care (PPC) have been broadly defined, identifying individual patients to receive PPC has been problematic in practice. The Paediatric Palliative Screening scale (PaPaS) is a multi-dimensional tool that assesses palliative care needs in children and families to facilitate timely referrals. This study evaluates its use to manage new referrals and ongoing review of patients receiving home-based PPC in Singapore. METHODS Using a retrospective cohort study design, 199 patients admitted to receive PPC via clinician screening were scored using PaPaS. Eighty-four patients in two groups were scored again at one of two following milestones: one-year service continuation mark or point of discharge before a year. Accuracy measures were compared against clinical assessment. RESULTS 96.98% of patients scored 15 and above on admission (indicating need for PPC). Patients assessed at following milestones were effectively stratified; those who continued to receive service after 1 year scored significantly higher (M = 19.23) compared to those who were discharged within a year (M = 7.86). Sensitivity and specificity for PaPaS were calculated at 82.54 and 100% respectively. Overall congruence with clinician-based decisions supports the utility of PaPaS as a screening tool in PPC. Recommendations to improve the scale further are proposed. CONCLUSION The PaPaS is a practical screening tool that signposts PPC needs within the clinical setting. This facilitates early referrals to PPC, without having to specify individual prognoses that are often uncertain. Other benefits include optimised continuity of care and implications for resource allocation.

中文翻译：

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谁需要并且继续需要儿科姑息治疗？儿科姑息筛查量表（PaPaS）的实用性和可行性评估。

背景技术虽然已经广泛定义了可以从儿科姑息治疗（PPC）中受益的儿童人群，但在实践中确定要接受PPC的个体患者却是一个难题。儿科姑息筛查量表（PaPaS）是一种多维工具，可评估儿童和家庭的姑息治疗需求，以利于及时转诊。这项研究评估了其用于管理新的转诊以及在新加坡对正在接受家庭PPC的患者进行的持续审查。方法采用回顾性队列研究设计，通过PaPaS对199名通过临床医生筛查而接受PPC的患者进行评分。两组中的84例患者在以下两个里程碑之一中再次得分：一年服务延续标记或一年前出院点。将准确性测量与临床评估进行比较。结果96.98％的患者入院时得分在15分以上（表明需要PPC）。按照以下里程碑进行评估的患者得到了有效分层。与一年内出院的人相比，一年后继续接受服务的人的得分（M = 19.23）要高得多（M = 7.86）。PaPaS的敏感性和特异性分别为82.54和100％。与基于临床医生的决策的整体一致性支持PaPaS作为PPC筛选工具的效用。提出了进一步扩大规模的建议。结论PaPaS是一种实用的筛查工具，可在临床环境中指示PPC的需求。这有助于尽早转诊至PPC，而不必指定通常不确定的单个预后。