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van den Brink DA, de Vries ISA, Datema M, Perot L, Sommers R, Daams J, Calis JCJ, Brals D, Voskuijl W. Predicting Clinical Deterioration and Mortality at Differing Stages During Hospitalization: A Systematic Review of Risk Prediction Models in Children in Low- and Middle-Income Countries. J Pediatr 2023; 260:113448. [PMID: 37121311 DOI: 10.1016/j.jpeds.2023.113448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/16/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To determine which risk prediction model best predicts clinical deterioration in children at different stages of hospital admission in low- and middle-income countries. METHODS For this systematic review, Embase and MEDLINE databases were searched, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The key search terms were "development or validation study with risk-prediction model" AND "deterioration or mortality" AND "age 0-18 years" AND "hospital-setting: emergency department (ED), pediatric ward (PW), or pediatric intensive care unit (PICU)" AND "low- and middle-income countries." The Prediction Model Risk of Bias Assessment Tool was used by two independent authors. Forest plots were used to plot area under the curve according to hospital setting. Risk prediction models used in two or more studies were included in a meta-analysis. RESULTS We screened 9486 articles and selected 78 publications, including 67 unique predictive models comprising 1.5 million children. The best performing models individually were signs of inflammation in children that can kill (SICK) (ED), pediatric early warning signs resource limited settings (PEWS-RL) (PW), and Pediatric Index of Mortality (PIM) 3 as well as pediatric sequential organ failure assessment (pSOFA) (PICU). Best performing models after meta-analysis were SICK (ED), pSOFA and Pediatric Early Death Index for Africa (PEDIA)-immediate score (PW), and pediatric logistic organ dysfunction (PELOD) (PICU). There was a high risk of bias in all studies. CONCLUSIONS We identified risk prediction models that best estimate deterioration, although these risk prediction models are not routinely used in low- and middle-income countries. Future studies should focus on large scale external validation with strict methodological criteria of multiple risk prediction models as well as study the barriers in the way of implementation. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews: Prospero ID: CRD42021210489.
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Affiliation(s)
- Deborah A van den Brink
- Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
| | - Isabelle S A de Vries
- Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Myrthe Datema
- Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Lyric Perot
- Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Ruby Sommers
- Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Joost Daams
- Medical Library, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Job C J Calis
- Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands; Department of Paediatrics and Child Health, Kamuzu University of Health Sciences (formerly College of Medicine), Blantyre, Malawi; Pediatric Intensive Care, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Daniella Brals
- Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Wieger Voskuijl
- Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands; Department of Paediatrics and Child Health, Kamuzu University of Health Sciences (formerly College of Medicine), Blantyre, Malawi
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Kumar R, Sharan S, Kishore S, Prakash J. The Various Scoring Systems in Pediatric Intensive Care Units: A Prospective Observational Study. Cureus 2023; 15:e39679. [PMID: 37398718 PMCID: PMC10311576 DOI: 10.7759/cureus.39679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND The discrimination power of the pediatric risk of mortality (PRISM), pediatric index of mortality (PIM), sequential organ failure assessment (SOFA), and pediatric logistic organ dysfunction (PELOD) may not always be true for countries such as India due to differences in factors from those nations where these scoring systems were validated. Therefore, this study was undertaken to determine and compare severity, course of illness, and outcomes in critically ill children admitted to the pediatric intensive care unit (PICU) using different scoring systems such as PRISM 4, PIM 3, PELOD 2, and the pediatric sequential organ failure assessment (pSOFA ) score, and to analyze the clinical spectrum and demographic profile of children admitted to the PICU. MATERIALS AND METHOD This was a prospective, single-center, observational study conducted in the PICU of the Indira Gandhi Institute of Medical Science, Patna, India, over two years. Two hundred children in the age group of one month to 14 years admitted to the PICU were recruited into the study. Prognostic scoring systems, including PRISM4 and PIM3, were used to compare the outcome, mortality, and length of PICU stay, whereas PELODS and pSOFA were descriptive scores that assessed the multiorgan dysfunction. A correlation between the different scoring systems and the outcome was determined. RESULTS The majority of children (26.5%, n=53) were one to three years of age. The maximum number of patients was male (66.5%, n=133). Renal complications were the predominant admission diagnosis in 19% (n=38) of children. The mortality rate was found to be 18.5%. The mortality was most common in infants <1 year of age (n=11, 29.73%) and those of the male sex (n=22, 59.46%). A significant correlation was found between length of stay and mortality (p<0.00001). A significant positive correlation was observed between mortality and PRISM 4, PIM 3, PELOD 2, and pSOFA scores on the first day of admission (p<0.00001). The pSOFA and PELOD2 showed better discrimination power (area under the curve (AUC): 0.77 and 0.74, respectively). CONCLUSION The study concluded that the pSOFA and PELOD2 scores are reliable predictors of mortality in critically ill children.
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Affiliation(s)
- Rakesh Kumar
- Pediatrics, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Shambhavi Sharan
- Pediatrics, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Sunil Kishore
- Pediatrics, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Jayant Prakash
- Pediatrics, Indira Gandhi Institute of Medical Sciences, Patna, IND
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Durak C, Sahin EG, Can YY, Sarisaltik A, Guvenc KB. The value of prognostic markers for pediatric trauma patients. World J Emerg Med 2023; 14:448-453. [PMID: 37969210 PMCID: PMC10632752 DOI: 10.5847/wjem.j.1920-8642.2023.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/10/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Despite the rapid development of pediatric intensive care medicine, there are still limited data in the literature regarding the follow-up of pediatric trauma patients in pediatric intensive care units (PICUs). In this study, we aim to evaluate our experience with children admitted and followed up with the diagnosis of trauma at our PICU. METHODS We evaluated the retrospective data of 77 pediatric trauma patients who were admitted to the PICU at Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital from August 2020 to December 2022. The demographic data, clinical parameters and laboratory results were recorded. The primary outcome was the mortality in PICU. The performances of markers in predicting mortality were evaluated with receiver operating characteristic (ROC) curves. RESULTS The median age of the patients was 70 (33-157) months, and the median duration of hospitalization in the PICU was 6 (2-11) d. Of the 77 patients, 9 died due to trauma (11,1%). Among the clinical parameters, Pediatric Risk of Mortality III (PRISM III) Score, inotrope requirement, extracorporeal treatment requirement, and mechanical ventilator requirement were significantly higher in non-survivors than in survivors. Among the laboratory parameters, procalcitonin (PCT), lactate/albumin ratio (LAR), neutrophil/lymphocyte ratio (NLR), and transfusion requirement were significantly higher in non-survivors than in survivors. CONCLUSION In pediatric trauma patients, baseline PCT, LAR, and NLR values can be used to identify patients at risk for mortality.
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Affiliation(s)
- Cansu Durak
- Department of Pediatric Intensive Care, Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital, Health Science University, Istanbul 34785, Türkiye
| | - Ebru Guney Sahin
- Department of Pediatric Intensive Care, Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital, Health Science University, Istanbul 34785, Türkiye
| | - Yasar Yusuf Can
- Department of Pediatric Intensive Care, Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital, Health Science University, Istanbul 34785, Türkiye
| | - Alican Sarisaltik
- Republic of Türkiye Ministry of Health, Cayirova District Health Directorate, Kocaeli 41420, Türkiye
| | - Kubra Boydag Guvenc
- Department of Pediatric Intensive Care, Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital, Health Science University, Istanbul 34785, Türkiye
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Chegini V, Hatamabadi H, Jedari Attaran S, Mahyar A, Mirzadeh M, Chegini V. Evaluating the Ability of PRISM4 and PIM3 to Predict Mortality in Patients Admitted to Pediatric Intensive Care Unit; a Diagnostic Accuracy Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e58. [PMID: 36033994 PMCID: PMC9397587 DOI: 10.22037/aaem.v10i1.1738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction Limited resources and the large number of children in need of services in the pediatric intensive care unit (PICU) emphasize the need for effective allocation of resources for improving the outcome of at-risk patients. This study aimed to evaluate and compare the accuracy of PRISM4 and PIM3 systems in prediction of in-hospital mortality of patients admitted to PICU. Methods The present retrospective cross-sectional study was a diagnostic accuracy study performed on patients admitted to PICU of Qods Hospital, Qazvin, Iran, during one year. Scores of PRISM4 and PIM3 scales were calculated for each patient using the available calculators, and the outcome of patients regarding in-hospital mortality was recorded. Finally, screening performance characteristics of the mentioned scales in prediction of patients' mortality were calculated and reported. Results 218 patients with the mean age of 40.68 ± 37.92 (2-160) months were studied (57.8% female). There was a significant direct correlation between PIM3 score and duration of stay in PICU (p < 0.0001; r = 0.259), need for inotropic drug administration (p = 0.001), and mortality rate (p = 0.001). In addition, area under the receiver operating characteristic (ROC) curve of PIM3 and PRISM4 in prediction of mortality among patients admitted to the PICU was 0.939 (95%CI: 0.880 - 0.998) and 0.660 (95%CI: 0.371 - 0.950), respectively (p = 0.001). Based on the findings, the best cut-off point for PIM3 scale in prediction of mortality was the score of 4 and it was estimated to be the core of 8 for PRISM4 scale. Sensitivity and specificity of PIM3 scale in prediction of mortality in the cut-off of 4 points were 100.00 (95% CI: 56.09- 100.00) and 81.51 (95% CI: 75.47- 86.38), respectively. These measures were 42.85 (95%CI: 11.80- 79.76) and 98.10 (95%CI: 94.89- 99.39) for PRISM4 model, which indicates the higher sensitivity of PIM3 system in this regard. Conclusion based on the results of the present study, the accuracy of PIM3 is significantly higher than PRISM4 in prediction of in-hospital mortality among patients admitted to the PICU. It seems that considering the 100% sensitivity of PIM3 in prediction of outcome, this model is a better tool for screening patients who are at risk for in-hospital mortality in order to pay more attention and allocate more resources to improve their outcome.
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Affiliation(s)
- Victoria Chegini
- Department of Pediatrics, School of Medicine, Shahid Beheshti University of Medical Sciences
| | - Hamidreza Hatamabadi
- Department of Emergency Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences
| | - Sima Jedari Attaran
- Department of Pediatrics, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Abolfazl Mahyar
- Department of Pediatrics, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Monirsadat Mirzadeh
- Department of Community Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Venus Chegini
- Department of Obstetrics and Gynecology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran,Corresponding author: Venus Chegini; Department of Obstetrics and Gynecology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. , ORCID: 0000-0002-8031-5840 , Phone: 00989123815963
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Toteja N, Sasidharan R, Kumar S, Zaman K, Singh VK, Jaiswal V, Srivastava K, Tiwari H, Mittal M. Role of Serum Ferritin and PRISM-III in Predicting Mortality in Children with Acute Encephalitis Syndrome in Northern India. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1750301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
AbstractThe aim of this study was to evaluate the role of serum ferritin (SF) and PRISM-III (Pediatric Risk of Mortality) score in predicting mortality in critically ill children aged 6 months to 15 years diagnosed with acute encephalitis syndrome (AES) admitted to the pediatric intensive care unit (PICU). This prospective observational study was conducted in the PICU of a tertiary teaching hospital in Northern India between July 2018 and June 2019. The primary outcome was to determine the association of admission SF levels with mortality. Secondary outcomes included estimating the prevalence of hyperferritinemia and comparing SF with PRISM-III scores in predicting mortality. Etiology could be established in 85.5% (n = 219) of the 256 children enrolled. Scrub typhus accounted for nearly two-thirds of the cases (60.5%), while dengue and Japanese encephalitis were the next common diagnoses. The median [interquartile range] SF at admission was significantly higher among the nonsurvivors than survivors: 514 [260–1,857] and 318 [189–699] µg/L, respectively (p = 0.029). SF and PRISM-III independently predicted mortality in AES. However, both had poor discriminatory power with area under receiver operating curve (95% confidence interval) of 0.61 (0.51–0.72) and 0.67 (0.56–0.77), respectively. Elevated SF and higher PRISM-III scores independently predicted mortality in children admitted to PICU with AES.
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Affiliation(s)
- Nisha Toteja
- Department of Paediatrics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Rohit Sasidharan
- Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sachin Kumar
- Department of Paediatrics, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
| | - Kamran Zaman
- Indian Council of Medical Research- Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
| | - Vijay Kumar Singh
- Department of Paediatrics, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
| | - Vineet Jaiswal
- Department of Paediatrics, Autonomous State Medical College, Deoria, Uttar Pradesh, India
| | - Kanchan Srivastava
- Department of Pathology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
| | - Harish Tiwari
- Department of Community Medicine, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
| | - Mahima Mittal
- Department of Paediatrics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
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Rahmatinejad Z, Rahmatinejad F, Sezavar M, Tohidinezhad F, Abu-Hanna A, Eslami S. Internal validation and evaluation of the predictive performance of models based on the PRISM-3 (Pediatric Risk of Mortality) and PIM-3 (Pediatric Index of Mortality) scoring systems for predicting mortality in Pediatric Intensive Care Units (PICUs). BMC Pediatr 2022; 22:199. [PMID: 35413854 PMCID: PMC9004120 DOI: 10.1186/s12887-022-03228-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The study was aimed to assess the prognostic power The Pediatric Risk of Mortality-3 (PRISM-3) and the Pediatric Index of Mortality-3 (PIM-3) to predict in-hospital mortality in a sample of patients admitted to the PICUs. DESIGN AND METHODS The study was performed to include all children younger than 18 years of age admitted to receive critical care in two hospitals, Mashhad, northeast of Iran from December 2017 to November 2018. The predictive performance was quantified in terms of the overall performance by measuring the Brier Score (BS) and standardized mortality ratio (SMR), discrimination by assessing the AUC, and calibration by applying the Hosmer-Lemeshow test. RESULTS A total of 2446 patients with the median age of 4.2 months (56% male) were included in the study. The PICU and in-hospital mortality were 12.4 and 16.14%, respectively. The BS of the PRISM-3 and PIM-3 was 0.088 and 0.093 for PICU mortality and 0.108 and 0.113 for in-hospital mortality. For the entire sample, the SMR of the PRISM-3 and PIM-3 were 1.34 and 1.37 for PICU mortality and 1.73 and 1.78 for in-hospital mortality, respectively. The PRISM-3 demonstrated significantly higher discrimination power in comparison with the PIM-3 (AUC = 0.829 vs 0.745) for in-hospital mortality. (AUC = 0.779 vs 0.739) for in-hospital mortality. The HL test revealed poor calibration for both models in both outcomes. CONCLUSIONS The performance measures of PRISM-3 were better than PIM-3 in both PICU and in-hospital mortality. However, further recalibration and modification studies are required to improve the predictive power to a clinically acceptable level before daily clinical use. PRACTICE IMPLICATIONS The calibration of the PRISM-3 model is more satisfactory than PIM-3, however both models have fair discrimination power.
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Affiliation(s)
- Zahra Rahmatinejad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Rahmatinejad
- Department of Medical Records and Health Information Technology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Sezavar
- Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariba Tohidinezhad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC - Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. .,Department of Medical Informatics, Amsterdam UMC - Location AMC, University of Amsterdam, Amsterdam, the Netherlands.
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Lion RP, Vega MR, Smith EO, Devaraj S, Braun MC, Bryan NS, Desai MS, Coss-Bu JA, Ikizler TA, Akcan Arikan A. The effect of continuous venovenous hemodiafiltration on amino acid delivery, clearance, and removal in children. Pediatr Nephrol 2022; 37:433-441. [PMID: 34386851 DOI: 10.1007/s00467-021-05162-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In critically ill children with acute kidney injury (AKI), continuous kidney replacement therapy (CKRT) enables nutrition provision. The magnitude of amino acid loss during continuous venovenous hemodiafiltration (CVVHDF) is unknown and needs accurate quantification. We investigated the mass removal and clearance of amino acids in pediatric CVVHDF. METHODS This is a prospective observational cohort study of patients receiving CVVHDF from August 2014 to January 2016 in the pediatric intensive care unit (PICU) of a tertiary children's hospital. RESULTS Fifteen patients (40% male, median age 2.0 (IQR 0.7, 8.0) years) were enrolled. Median PICU and hospital lengths of stay were 20 (9, 59) and 36 (22, 132) days, respectively. Overall survival to discharge was 66.7%. Median daily protein prescription was 2.00 (1.25, 2.80) g/kg/day. Median daily amino acid mass removal was 299.0 (174.9, 452.0) mg/kg body weight, and median daily amino acid mass clearance was 18.2 (13.5, 27.9) ml/min/m2, resulting in a median 14.6 (8.3, 26.7) % protein loss. The rate of amino acid loss increased with increasing dialysis dose and blood flow rate. CONCLUSION CVVHDF prescription and related amino acid loss impact nutrition provision, with 14.6% of the prescribed protein removed. Current recommendations for protein provision for children requiring CVVHDF should be adjusted to compensate for circuit-related loss. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Richard P Lion
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Molly R Vega
- Section of Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - E O'Brien Smith
- Department of Pediatrics and Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Sridevi Devaraj
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Michael C Braun
- Section of Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Nathan S Bryan
- Department of Pediatrics and Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Moreshwar S Desai
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jorge A Coss-Bu
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Talat Alp Ikizler
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ayse Akcan Arikan
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. .,Section of Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. .,Texas Children's Hospital, 6651 Main Street, Houston, TX, 77030, USA.
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8
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Paskaradevan J, Zier M, Rissmiller B, Katkin JP, Coss-Bu JA, Gazzaneo MC. Pulmonary specialist involvement in critical asthma in the pediatric intensive care unit: A retrospective review. Pediatr Pulmonol 2022; 57:395-402. [PMID: 34861100 DOI: 10.1002/ppul.25780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Asthma is one of the most common chronic diseases of childhood. There is a scarcity of published literature on critical asthma, considered acute asthma requiring pediatric intensive care unit (PICU) admission. The goal of this study was to describe the clinical care of children with critical asthma admitted to a single center PICU and to determine whether pulmonary medicine consultation during admission impacted outcomes. METHODS Retrospective chart review of known asthma patients aged 4-18 years admitted to a quaternary PICU between 01/2013 and 07/2019 for management of critical asthma. RESULTS A total of 179 patients were enrolled with median age of 8 years. Median hospital length of stay (LOS) was 3.2 days and PICU LOS was 1.5 days. A total of 80 (44.7%) patients had a pulmonary medicine consultation. In the pulmonary medicine consultation group versus the no-pulmonary medicine consultation group, there was a significant difference in hospital LOS (4.16 vs. 2.86 days, p value <.0001) and PICU LOS (2.00 vs. 1.00, p value <.0001), escalation of controller medication (66% vs. 21%, p value <.0001), scheduled outpatient pulmonology follow-up (87.5% vs. 45.4%, p value <.0001), and receiving ≥3 courses of systemic steroids in the 12 months after discharge (32.2% vs. 14.7%). There was no difference in attendance of scheduled follow up appointments or in having ≥3 emergency room visits or admissions in the 12 months after discharge. CONCLUSION Pulmonary medicine consultation during hospital admission may impact management of critical asthma by increasing escalation of controller medication and scheduled outpatient follow up.
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Affiliation(s)
- Janaki Paskaradevan
- Section of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Mackenzie Zier
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Brian Rissmiller
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Julie P Katkin
- Section of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Jorge A Coss-Bu
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - M Carolina Gazzaneo
- Section of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Baloch SH, Shaikh I, Gowa MA, Lohano PD, Ibrahim MN. Comparison of Pediatric Sequential Organ Failure Assessment and Pediatric Risk of Mortality III Score as Mortality Prediction in Pediatric Intensive Care Unit. Cureus 2022; 14:e21055. [PMID: 35155020 PMCID: PMC8825229 DOI: 10.7759/cureus.21055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 01/09/2023] Open
Abstract
Objective: To assess and compare the diagnostic accuracy of the Pediatric Risk of Mortality (PRISM) III score and Pediatric Sequential Organ Failure Assessment (p-SOFA) for the prediction of mortality in critically ill children. Methodology: This was a cross-validation study conducted at the Pediatric Intensive Care Unit (PICU) of the National Institute of Child Health Karachi from February 2021 to July 2021. Two hundred eighty-six critically ill children of age one month to 15 years of either gender staying in PICU for more than 24 hours were included. Within 24 hours of admission, the p-SOFA and PRISM III 24 scores were calculated for all eligible children. The outcome of the study was mortality within 30 days of PICU admitted children. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23. Results: The median age was 24 months (range: 1-144 months). The 30-day mortality was estimated as 57%. The p-SOFA and PRISM scores were significantly greater in children who did not survive than survivors. The maximum p-SOFA score (area under the curve (AUC)=0.81, 95% CI=0.76-0.86, p=0.001) and PRISM III 24 score (AUC=0.75, 95% CI=0.69-0.81, p=0.001) had good discrimination for 30-day mortality. For the prediction of 30-day mortality at the cut-off value of p-SOFA>2, the sensitivity was 93.87%, specificity was 38.21%, and accuracy was 69.93%. Whereas at the cut-off value of PRISM III 24 score>8, the sensitivity was 55.83%, specificity was 77.24%, and accuracy was 65.03%. Conclusion: The p-SOFA score is a good predictor for 30-day mortality in critically ill children and had better accuracy than the PRISM III 24 score.
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10
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Shen Y, Jiang J. Meta-Analysis for the Prediction of Mortality Rates in a Pediatric Intensive Care Unit Using Different Scores: PRISM-III/IV, PIM-3, and PELOD-2. Front Pediatr 2021; 9:712276. [PMID: 34504815 PMCID: PMC8421854 DOI: 10.3389/fped.2021.712276] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/22/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction: The risk of mortality is higher in pediatric intensive care units (PICU). To prevent mortality in critically ill infants, optimal clinical management and risk stratification are required. Aims and Objectives: To assess the accuracy of PELOD-2, PIM-3, and PRISM-III/IV scores to predict outcomes in pediatric patients. Results: A total of 29 studies were included for quantitative synthesis in meta-analysis. PRISM-III/IV scoring showed pooled sensitivity of 0.78; 95% CI: 0.72-0.83 and pooled specificity of 0.75; 95% CI: 0.68-0.81 with 84% discrimination performance (SROC 0.84, 95% CI: 0.80-0.87). In the case of PIM-3, pooled sensivity 0.75; 95% CI 0.71-0.79 and pooled specificity 0.76; 95% CI 0.73-0.79 were observed with good discrimination power (SROC, 0.82, 95% CI 0.78-0.85). PELOD-2 scoring system had pooled sensitivity of 0.78 (95% CI: 0.71-0.83) and combined specificity of 0.75 (95% CI: 0.68-0.81), as well as good discriminating ability (SROC 0.83, 95% CI: 0.80-0.86) for mortality prediction in PICU patients. Conclusion: PRISM-III/IV, PIM-3, and PELOD-2 had good performance for mortality prediction in PICU but with low to moderate certainty of evidence. More well-designed studies are needed for the validation of the study results.
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Affiliation(s)
- Yaping Shen
- Department of Pediatrics, Shengzhou People's Hospital, the First Affiliated Hospital of Zhejiang University Shengzhou Branch, Shaoxing, China
| | - Juan Jiang
- NICU, Ningbo Women and Children's Hospital, Ningbo, China
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Albuali WH, Algamdi AA, Hasan EA, Al-Qahtani MH, Yousef AA, Al Ghamdi MA, Bubshait DK, Alshahrani MS, AlQurashi FO, Bou Shahmah TA, Awary BH. Use of a Mortality Prediction Model in Children on Mechanical Ventilation: A 5-Year Experience in a Tertiary University Hospital. J Multidiscip Healthc 2020; 13:1507-1516. [PMID: 33204099 PMCID: PMC7667207 DOI: 10.2147/jmdh.s282108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Currently, several scoring systems for predicting mortality in severely ill children who require treatment in a pediatric intensive care unit (PICU) have been established. However, despite providing high-quality care, children might develop complications that can cause rapid deterioration in health status and can lead to death. Hence, this study aimed to establish a simple early predictive mortality (SEPM) model with high specificity in identifying severely ill children who would possibly benefit from extensive mechanical ventilation during PICU admission. Patients and Methods This is a retrospective longitudinal study that included pediatric patients aged older than two weeks who were on mechanical ventilation and were admitted to the PICU of King Fahd Hospital of the University from January 2015 to December 2019. Results In total, 400 pediatric patients were included in this study. The mortality rate of children on mechanical ventilation was 28.90%, and most deaths were associated with respiratory (n = 124 [31%]), cardiovascular (n = 76 [19%]), and neurological (n = 68 [17%]) causes. The SEPM model was reported to be effective in predicting mortality, with an accuracy, specificity, and sensitivity of 92.5%, 97.31%, and 66.15%, respectively. Moreover, the accuracy, specificity, and sensitivity of the Pediatric Risk of Mortality (PRISM) III score in predicting mortality was 95.25%, 98.51%, and 78.46%, respectively. Conclusion The SEPM model had a high specificity for mortality prediction. In this model, only six clinical predictors were used, which might be easily obtained in the early period of PICU admission. The ability of the SEPM model and the PRISM III score in predicting mortality in severely ill children was comparable. However, the accuracy of the newly established model in other settings should be validated, and a prospective longitudinal study that considers the effect of the treatment on the model’s predictive ability must be conducted.
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Affiliation(s)
- Waleed H Albuali
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Amal A Algamdi
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Elham A Hasan
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammad H Al-Qahtani
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah A Yousef
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammad A Al Ghamdi
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Dalal K Bubshait
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed S Alshahrani
- Emergency and Critical Care Medicine Departments, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal O AlQurashi
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Talal A Bou Shahmah
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Bassam H Awary
- Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Kaur A, Kaur G, Dhir SK, Rai S, Sethi A, Brar A, Singh P. Pediatric Risk of Mortality III Score - Predictor of Mortality and Hospital Stay in Pediatric Intensive Care Unit. J Emerg Trauma Shock 2020; 13:146-150. [PMID: 33013095 PMCID: PMC7472814 DOI: 10.4103/jets.jets_89_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/22/2019] [Accepted: 02/03/2020] [Indexed: 11/04/2022] Open
Abstract
Background Pediatric Risk of Mortality (PRISM) III score is one of the widely used scoring systems to quantify critical illness in the pediatric age group. This study was carried out to find the association of PRISM III score with the outcome (discharge/mortality) and also hospital stay in survivors and nonsurvivors. Setting The study was conducted in a tertiary care hospital from January 2014 to June 2015. Materials and Methods A total of 524 patients were admitted, and after excluding the patients who met the exclusion criteria, 486 patients were analyzed. Statistical Analysis Logistic regression was used to find the association of variables under the PRISM III score with mortality. Linear regression was used to find the association of PRISM III score with length of stay. Results Mortality was 31%; male: female ratio was 1.5:1. Maximum patients presented with respiratory system involvement (26.3%), and maximum mortality (20.3%) was observed in the patients with respiratory involvement. Discrimination by the model between mortality and survival was excellent (receiver operating characteristic curve [0.903]). Maximum risk of mortality was noticed in mechanically ventilated patients (odds ratio [OR]: 10.87) followed by lower systolic blood pressure (OR: 2.72), deranged prothrombin time, partial thromboplastin time (OR: 1.50), deranged mental status (OR: 1.41), and tachycardia (OR: 1.37). Length of stay (LOS) in patients increased till PRISM III score of 25. Average LOS in survivors was 4.327 days which was not accounted by difference in PRISM III score between different patients. With each unit increase in PRISM III score, LOS increased by 5 h. Conclusions PRISM III score has excellent capacity to discriminate between survival and mortality. PRISM III score can be used to predict LOS among survivors.
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Affiliation(s)
- Amarpreet Kaur
- Department of Pediatrics, Guru Gobind Singh Medical College and Hospital, Faridkot, India
| | - Gurmeet Kaur
- Department of Pediatrics, Guru Gobind Singh Medical College and Hospital, Faridkot, India
| | - Shashi Kant Dhir
- Department of Pediatrics, Guru Gobind Singh Medical College and Hospital, Faridkot, India
| | - Seema Rai
- Department of Pediatrics, Guru Gobind Singh Medical College and Hospital, Faridkot, India
| | - Amanpreet Sethi
- Department of Pediatrics, Guru Gobind Singh Medical College and Hospital, Faridkot, India
| | - Avneet Brar
- Department of Pediatrics, Government Medical College and Hospital, Amritsar, Punjab, India
| | - Paramdeep Singh
- Department of Radiology, Guru Gobind Singh Medical College and Hospital, Faridkot, India
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Mirza S, Malik L, Ahmed J, Malik F, Sadiq H, Ali S, Aziz S. Accuracy of Pediatric Risk of Mortality (PRISM) III Score in Predicting Mortality Outcomes in a Pediatric Intensive Care Unit in Karachi. Cureus 2020; 12:e7489. [PMID: 32368422 PMCID: PMC7193246 DOI: 10.7759/cureus.7489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background With the advancements in medicine and increasing access to modern technology, pediatric intensive care units (PICU) are becoming a vital part of any health care setting. PICUs play a key role in saving the life of young patients. Various scales have been designed by researchers to aid in predicting the mortality of a patient admitted in PICU. Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality (PIM) are among the most commonly used scales. Calculating the risk of mortality enables the physicians to classify the patients and helps in identifying which patients require more urgent care and resources. Methods A hospital-based prospective study was carried out at PICU in a tertiary care hospital in Karachi from December 2017 to June 2019. All patients between the age of one month and 12 years were included in our study after informed consent from parents/guardians. A standard questionnaire was used and the PRISM III score was calculated at 24 hours of admission. All necessary investigations were carried out, and all statistical analyses were carried out using SPSS v.23 (IBM, Armonk, NY). Results A total of 407 patients were included in our study with the majority being males (54.5%). The mean age was 27±33 months. The mean duration of stay of patients in PICU was 80.15±36.58 hours. The mortality rate in our study was 37.35 % (n=152). The need for mechanical ventilation, use of inotropic drugs, higher temperatures, and low Glasgow Coma Scale scores were associated with poor survival. It was noted that as the PRISM III score increased, the mortality rate also increased. In our study, we found that PRISM III had good predictive power in our population. The area under the curve was 0.903±0.016 (p<0.001, 95% confidence interval: 0.872-0.934). Conclusions PRISM III score showed excellent accuracy and predictive ability in our population. There was no significant difference in observed and expected mortality rates in our study. In a resource-limited setting, the prediction models highlight the cases where more medical attention is required and also enable the physicians to assess the prognosis of the patient so adequate measures can be taken beforehand.
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Affiliation(s)
- Sadiq Mirza
- Pediatric Critical Care, The Indus Hospital, Karachi, PAK
| | - Laraib Malik
- Pediatrics, Abbasi Shaheed Hospital, Karachi, PAK
| | - Jawad Ahmed
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Farheen Malik
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Hassaan Sadiq
- Surgery, Civil Hospital, Dow University of Health Sciences, Karachi, PAK
| | - Sanower Ali
- Community Health Science, Jinnah Dental and Medical College, Karachi, PAK
| | - Sina Aziz
- Pediatrics, Karachi Medical and Dental College, Karachi, PAK
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Barboza CL, Valete CO, da Silva AR. Bundle Adherence of Intravenous Antibiotic Fluid Resuscitation and Vasopressor in Children with Severe Sepsis or Septic Shock. Indian J Crit Care Med 2020; 24:128-132. [PMID: 32205945 PMCID: PMC7075055 DOI: 10.5005/jp-journals-10071-23336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective The aim of this study was to measure the effects of a bundle of interventions in children admitted with severe sepsis or septic shock in the first hour after diagnosis on mortality. Materials and methods A retrospective study was conducted at a pediatric intensive care unit (PICU) between January 2014 and January 2016. Three interventions (intravenous [IV] antibiotic, fluid boluses, and vasopressor administration) applied in the first hour of severe sepsis or septic shock diagnosis were analyzed according to their adherence rates. The main outcome was mortality. Odds ratios were calculated. Results Of a total of 530 PICU admissions, 105 patients met the criteria for sepsis, 53 (50.5%) with severe sepsis and 52 (49.5%) with septic shock. Seventy-two (68.6%) patients received IV antibiotic within the first hour, 65 (61.9%) received IV fluid bolus, and 55 (53.3%) received a vasopressor drug. Fifty-two (49.5%) patients received concomitant IV antibiotics and fluid bolus. Blood cultures were collected before IV antibiotic administration in 87 (82.9%) out of 105 patients. Thirteen (12.4%) patients died, 1 with severe sepsis and 12 with septic shock. In a univariate analysis, the odds ratios for death and IV antibiotic were 6.39 (p value = 0.081, 95% CI = 0.795-51.465), 4.77 for fluid bolus between 21 and 40 mL/kg (p value = 0.013, 95% CI = 1.395-16.336), and 3.23 for vasopressor administration (p value < 0.0001, 95% CI = 1.734-6.018). In a multivariate analysis, the odds ratio of fluid bolus between 21 and 40 mL/kg was 42.66 (p value = 0.005, 95% CI = 3.117-583.841) and noradrenaline use was 23.93 (p value = 0.010, 95% CI = 2.124-269.750). Conclusion Adherence was observed for more than half of the single interventions as IV antibiotic, fluid resuscitation, and vasopressor administration in the first hour. The antibiotic administration alone was not associated with high mortality. Vasopressor administration was related to higher mortality but moderate fluid bolus was a protective factor associated with lower mortality. How to cite this article Barboza CL, Valete COS, da Silva ARA. Bundle Adherence of Intravenous Antibiotic Fluid Resuscitation and Vasopressor in Children with Severe Sepsis or Septic Shock. Indian J Crit Care Med 2020;24(2):128-132.
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Divecha C, Tullu MS, Chaudhary S. Burden of respiratory illnesses in pediatric intensive care unit and predictors of mortality: Experience from a low resource country. Pediatr Pulmonol 2019; 54:1234-1241. [PMID: 31087783 DOI: 10.1002/ppul.24351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/13/2019] [Accepted: 04/21/2019] [Indexed: 11/07/2022]
Abstract
INTRODUCTION AND OBJECTIVES Acute respiratory infections (ARI), a major cause of childhood mortality and morbidity, place substantial burden on health services worldwide. Due to scarce data regarding respiratory illnesses requiring Pediatric intensive care unit (PICU) admissions (especially in low income/developing countries), we studied the burden of respiratory illnesses in the PICU and the risk factors contributing to mortality. METHODS This prospective observational study was conducted over 18 months. Children (aged 1 month to 12 years) admitted to the PICU for acute respiratory/cardiorespiratory illnesses were enrolled. Demographic and clinical details of the study population were recorded and tabulated. Risk factors contributing to mortality (severity of illness [PRISM III score], diagnosis/etiology, need for mechanical ventilation, immunocompromised status, malnutrition, and length of stay [LOS]) were analyzed (using the χ2 test or Fischer Exact test). RESULTS Two hundred and ninety-three children were enrolled (median age: 5 months; range, 1-132 months; male/female: 181/112). Mean LOS in PICU was 5.25 ± 5.48 days and mean length of hospital stay of 14.82 ± 13.35 days. Mechanical ventilation was required in 62.8% cases. Pneumonia contributed to 66.89% of respiratory admissions and 91% of mortality. Ninety patients (30.7%) died; mortality being higher in cardiorespiratory cases (52.7%). PRISM III score and shock (respiratory cases) and age below 1 year (cardiorespiratory group) were significantly associated with higher mortality ( P < 0.05). CONCLUSIONS Respiratory illnesses are a significant contributor to PICU admissions and are associated with significant mortality risk in presence of high PRISM III score and shock (respiratory group); and age below 1 year (cardiorespiratory group).
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Affiliation(s)
- Chhaya Divecha
- Department of Pediatrics, Seth G. S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Milind S Tullu
- Department of Pediatrics, Seth G. S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Satish Chaudhary
- Department of Pediatrics, Seth G. S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
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Ziemba KJ, Kumar R, Nuss K, Estrada M, Lin A, Ayad O. Clinical Decision Support Tools and a Standardized Order Set Enhances Early Enteral Nutrition in Critically Ill Children. Nutr Clin Pract 2019; 34:916-921. [PMID: 30932259 DOI: 10.1002/ncp.10272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Critically ill children in a pediatric intensive care unit (PICU) have unique nutrition needs that are challenging to achieve and thus are at high risk of malnutrition. There is increasing evidence that children who reach caloric goals early have improved outcomes. The purpose of this initiative was to implement an enteral nutrition (EN) algorithm in a tertiary care PICU utilizing clinical decision support tools (CDSTs) and a standardized order set within an electronic health record. METHODS A quality improvement initiative was undertaken to implement an EN feeding protocol using electronic CDSTs, including a new standardized order set. RESULTS In a historical cohort of 376 patients, only 18% met goal EN in the first 48 hours of admission. The EN protocol was implemented in 272 patients who met 88% goal feed volume within 48 hours of intensive care unit admission. Median time to start EN (1.7 vs 1.3 days, P < 0.0001) and time to goal nutrition (2.8 vs 2.2 days, P < 0.001) improved after project implementation. Length of stay in the PICU was significantly reduced following protocol implementation (202 hours pre-implementation vs 156 hours post implementation, P < 0.0001). CONCLUSIONS We used CDSTs and standardized order sets to implement a nutrition algorithm to facilitate and likely improve the nutrition care of critically ill children.
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Affiliation(s)
- Keegan J Ziemba
- Nationwide Children's Hospital, Columbus, Ohio, USA.,Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | - Kathryn Nuss
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Ada Lin
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Onsy Ayad
- Nationwide Children's Hospital, Columbus, Ohio, USA
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Özmert S, Sever F, Ayar G, Yazıcı MU, Öztaş DK. Brain Death and Organ Donation in Paediatric Intensive Care Unit. Turk J Anaesthesiol Reanim 2019; 47:55-61. [PMID: 31276112 DOI: 10.5152/tjar.2019.43726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/16/2018] [Indexed: 11/22/2022] Open
Abstract
Objective The purpose of the present study was to retrospectively analyse the brain death (BD) cases that were specified within the last 8 years in the paediatric intensive care unit of our hospital. Methods Archive files and computer records of 23 paediatric cases were analysed. Data on age, gender, conditions that caused BD, paediatric risk of mortality (PRISM III) scores, time between suspicion of BD and issuing of BD report, confirmatory tests used, complications that occurred following the diagnosis of BD and time to cardiac arrest development after diagnosis of BD were recorded. Results The average age of the patients was 6.8±5.5 years. The most frequent cause of BD was intracranial haemorrhage (30.4%). The mean time to diagnosis after BD suspicion was 5.9±6.2 days. Electroencephalography was performed in 61% of the patients in addition to the apnoea test. Radiological imaging methods were used in 39% of the patients (n=9). Of the cases, 34.7% developed hypothermia, and 4.3% developed diabetes insipidus (DI). Among them, 43.4% had both DI and hypothermia. The mean PRISM score was calculated as 22±9.2. The donation rate of the families was 17%. The mean time to cardiac arrest development after diagnosis of BD was 6.9±7.4 days in non-donor cases where medical support had been reduced. Conclusion Any patient with a neurologically poor prognosis in the intensive care unit should be considered to develop BD and diagnosed with BD without delay. The donation rate will increase if family interviews are done by an experienced and educated coordinator.
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Affiliation(s)
- Sengül Özmert
- Department of Anaesthesiolgy and Reanimation, University of Health Sciences Ankara Child Health and Diseases Haematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Feyza Sever
- Department of Anaesthesiolgy and Reanimation, University of Health Sciences Ankara Child Health and Diseases Haematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ganime Ayar
- Department of Paediatric Intensive Care Unit, University of Health Sciences Ankara Child Health and Diseases Haematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Mutlu Uysal Yazıcı
- Department of Paediatric Intensive Care Unit, Hacettepe University İhsan Dogramacı Children's Hospital, Ankara, Turkey
| | - Dilek Kahraman Öztaş
- Department of Public Health, Yıldırım Beyazıt University School of Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
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Tzira D, Prezerakou A, Papadatos I, Vintila A, Bartzeliotou A, Apostolakou F, Papassotiriou I, Papaevangelou V. Salivary biomarkers may measure stress responses in critically ill children. SAGE Open Med 2018; 6:2050312118802452. [PMID: 30263122 PMCID: PMC6156207 DOI: 10.1177/2050312118802452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/29/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Measurement of salivary biomarkers can provide important information regarding hypothalamic-pituitary-adrenal axis activity both under normal conditions as well as in response to psychological or physical stress. Our aim was to correlate salivary stress markers, such as cortisol, α-amylase and immunoglobulin A, with the Pediatric Risk Index Score of Mortality, underlying disease (pathologic, trauma and postoperative), need for mechanical ventilation/sedation and time lag between onset of illness and admission in children admitted in the pediatric intensive care unit. METHODS We enrolled 79 pediatric intensive care unit patients (2-14 years) over a 2-year period, which satisfy the including criteria, but finally salivary biomarkers were evaluated in 65 patients. Saliva samples were collected within 24 h of admission at 8 a.m., 2 p.m. and 8 p.m. to examine potential disruption of circadian rhythm. RESULTS Overall, the salivary biomarkers were increased; specifically, median values were (a) cortisol at 8 a.m.: 50.04 nmol/L, 2 p.m.: 30.69 nmol/L and 8 p.m.: 247.12 nmol/L; (b) α-amylase: at 8 a.m.: 22.567 U/L; 2 p.m.: 22.702 U/L and 8 p.m.: 21.484 U/L and (c) IgA at 8 a.m.: 95.10 mg/dL, 2 p.m.: 88.55 mg/dL and 8 p.m.: 80.80 mg/dL. Significantly higher levels were demonstrated in children younger than 6 years and those with Pediatric Risk Index Score of Mortality ⩾8 upon admission. Disturbances in circadian rhythm were observed. Cortisol circadian rhythm disturbance was observed only in children with Pediatric Risk Index Score of Mortality score ⩾8 upon admission while maintaining normal α-amylase circadian rhythm, which was associated with less than 3 days hospitalization in pediatric intensive care unit. No daily variance in IgA was observed. CONCLUSION Salivary biomarkers may serve, in critically ill children, as a sensitive, non-invasive method, important for the early recognition of those at high risk and guiding intervention, before clinical deterioration, promoting the quality of health care in pediatric population.
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Affiliation(s)
- Despoina Tzira
- Pediatric Intensive Care Unit, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
| | | | - Ioannis Papadatos
- Pediatric Intensive Care Unit, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
| | - Artemis Vintila
- Department of Pediatrics, Thriasio General Hospital, Athens, Greece
| | | | - Filia Apostolakou
- Department of Clinical Biochemistry, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
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Can Pediatric Risk of Mortality Score (PRISM III) Be Used Effectively in Initial Evaluation and Follow-up of Critically Ill Cancer Patients Admitted to Pediatric Oncology Intensive Care Unit (POICU)? A Prospective Study, in a Tertiary Cancer Center in Egypt. J Pediatr Hematol Oncol 2018; 40:382-386. [PMID: 29176465 DOI: 10.1097/mph.0000000000001033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pediatric Risk of Mortality Score (PRISM III-12) is a physiology-based predictor for risk of mortality. We conducted prospective study from January 1, 2014 to 2015 in pediatric oncology intensive care unit (POICU) at South Egypt Cancer Institute, Egypt to explore the ability of 1st PRISM III-12 to predict the risk of mortality in critically ill cancer patients and the ability of serial PRISM III measured every 72 hours to follow-up the patients' clinical condition during POICU stay. In total, 123 (78 males) children were included. Median age was 5 years (1 to 15 y). Death rate was 20%. 1st PRISM III-12 mean was 19 (0 to 61). The mean 1st PRISM III-12 for survivors was significantly higher compared with nonsurvivors (15 vs. 37 respectively; P<0.001). 1st PRISM III-12 mean was significantly correlated to the reasons for admission and organ failures' number (P<0.001 and <0.001). 1st PRISM III-12 correlated weakly positive with the length of stay (r=0.2; P=0.024). Receiver operator curve for 1st PRISM III-12 was 0.913 (95% confidence interval, 0.85-0.98; P<0.001). Decline in serial PRISM III was significantly correlated with favorable (survivor) outcome (P<0.001). We concluded that PRISM III-12 can be used effectively in predicting the risk of mortality and following the clinical condition of patients during POICU stay.
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El Gendy FM, El-Mekkawy MS, Saleh NY, Habib MSED, Younis FE. Clinical study of Presepsin and Pentraxin3 in critically ill children. J Crit Care 2018; 47:36-40. [PMID: 29886065 DOI: 10.1016/j.jcrc.2018.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/30/2018] [Accepted: 06/02/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess the value of Presepsin and Pentraxin3 measurement in critically ill children. MATERIALS AND METHODS Prospective observational study conducted on 80 children admitted into Pediatric Intensive Care Unit (PICU) and 80 healthy controls. Patients were evaluated for presence of sepsis. Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality (PIM2) were calculated. Serum Presepsin and Pentraxin3 were measured within 24 h of admission. RESULTS Presepsin and Pentraxin3 were significantly higher among the whole patient cohort and among septic patients compared with controls (p < 0.001) but no difference was found between septic and non-septic patients. Pentraxin3, but not Presepsin, was significantly higher among non-survivors compared with survivors (p = 0.048) and was correlated with PIM2. Receiver operating characteristic (ROC) curve analysis revealed that Pentraxin3 had an AUC of 0.631 for prediction of mortality which was comparable to that of PRISM and PIM2. Presepsin was associated with a higher rate of mechanical ventilation and longer PICU stay. CONCLUSIONS Presepsin and Pentraxin3 are acute phase proteins potentially useful for monitoring critically ill children and diagnosing sepsis. Pentraxin3 is associated with mortality but modestly discriminates survivors from non-survivors. Presepsin is associated with certain indicators of disease severity. Larger studies are certainly required.
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Affiliation(s)
- Fady M El Gendy
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Egypt
| | | | - Nagwan Y Saleh
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Egypt.
| | | | - Faten Ezzelarab Younis
- Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Egypt
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Hamshary AAEE, Sherbini SAE, Elgebaly HF, Amin SA. Prevalence of multiple organ dysfunction in the pediatric intensive care unit: Pediatric Risk of Mortality III versus Pediatric Logistic Organ Dysfunction scores for mortality prediction. Rev Bras Ter Intensiva 2018; 29:206-212. [PMID: 28977260 PMCID: PMC5496755 DOI: 10.5935/0103-507x.20170029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/21/2016] [Indexed: 11/20/2022] Open
Abstract
Objectives To assess the frequency of primary multiple organ failure and the role of
sepsis as a causative agent in critically ill pediatric patients; and
calculate and evaluate the accuracy of the Pediatric Risk of Mortality III
(PRISM III) and Pediatric Logistic Organ Dysfunction (PELOD) scores to
predict the outcomes of critically ill children. Methods Retrospective study, which evaluated data from patients admitted from January
to December 2011 in the pediatric intensive care unit of the Children's
Hospital of the University of Cairo. Results Out of 237 patients in the study, 72% had multiple organ dysfunctions, and
45% had sepsis with multiple organ dysfunctions. The mortality rate in
patients with multiple organ dysfunction was 73%. Independent risk factors
for death were mechanical ventilation and neurological failure [OR: 36 and
3.3, respectively]. The PRISM III score was more accurate than the PELOD
score in predicting death, with a Hosmer-Lemeshow X2 (Chi-square
value) of 7.3 (df = 8, p = 0.5). The area under the curve was 0.723 for
PRISM III and 0.78 for PELOD. Conclusion A multiple organ dysfunctions was associated with high mortality. Sepsis was
the major cause. Pneumonia, diarrhea and central nervous system infections
were the major causes of sepsis. PRISM III had a better calibration than the
PELOD for prognosis of the patients, despite the high frequency of the
multiple organ dysfunction syndrome.
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Affiliation(s)
| | - Seham Awad El Sherbini
- Department of Pediatric Intensive Care, Faculty of Medicine, Cairo University - Cairo, Egypt
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Kalzén H, Larsson B, Eksborg S, Lindberg L, Edberg KE, Frostell C. Survival after PICU admission: The impact of multiple admissions and complex chronic conditions. PLoS One 2018; 13:e0193294. [PMID: 29621235 PMCID: PMC5886395 DOI: 10.1371/journal.pone.0193294] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 02/08/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Factors predicting survival over time after pediatric intensive care unit (PICU) admissions are not fully understood. The primary aim of the current study was to investigate whether multiple admissions (MADM) compared to single PICU admissions (SADM) were associated with poor survival over time after being admitted to PICU facilities. Our secondary aim was to investigate if the presence of a complex chronic condition (CCC) would further impair prognosis. DESIGN A closed cohort of all children up to 16 years of age admitted to the three PICUs in Sweden between 2008 and 2010 was prospectively collected and followed until 2012, providing survival data for at least one but up to four years of follow-up. SETTING Three Swedish tertiary referral centers for pediatric intensive care and extracorporeal membrane oxygenation (ECMO) care were used. PATIENTS In total, 3,688 Swedish children with 5,019 PICU admissions were included. INTERVENTIONS No interventions were conducted. MEASUREMENTS An extensive data set was recorded, including up to four-year survival information following first PICU admission. The patients were assigned to seven admission diagnostic groups, which were then divided into SADM or MADM groups. The difference in survival over time and mortality rates (MR) and mortality rate ratios (MRR) were calculated. SADM and MADM groups with and without an existing CCC were formed. The difference in survival over time between groups was calculated. MAIN RESULTS A highly significant difference in survival over time was noted between SADM and MADM patients (p<0.0001), which was intensified by the presence of a CCC. MADM patients with a CCC had the worst outcome, while SADM patients without a CCC had the best outcome. MADM patients with no CCC demonstrated decreased survival over time compared to SADM patients with a CCC. Survival over time was statistically worsened for patients with MADM compared to SADM for the following admission diagnostic groups: Cardiovascular, Gastrointestinal/Renal, Respiratory, Neurological, and Miscellaneous. The mortality rate (deaths/patient year of follow-up) during the time of follow-up was 0.023 for SADM and 0.062 for MADM patients. The mortality rate ratio (MRR) between these groups was 2.69. CONCLUSION Compared to single admissions, multiple admissions to PICU were associated with a significant decrease in survival over time in some but not all diagnostic groups. Regarding our secondary aim, we found that when the presence of a CCC is factored into the survival analysis, survival over time is further impaired.
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Affiliation(s)
- Håkan Kalzén
- Department of Paediatric Anaesthesia, Intensive Care and ECMO services, Astrid Lindgren Children's Hospital, Karolinska Institutet, Karolinska University Hospital (Solna), Stockholm, Sweden
| | - Björn Larsson
- Department of Paediatric Anaesthesia, Intensive Care and ECMO services, Astrid Lindgren Children's Hospital, Karolinska Institutet, Karolinska University Hospital (Solna), Stockholm, Sweden
| | - Staffan Eksborg
- Childhood Cancer Research Unit Q6:05, Department of Women's and Children's Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital (Solna), Stockholm, Sweden
| | - Lars Lindberg
- Department of Anaesthesia and Intensive Care, Children’s Hospital, Paediatric Intensive Care Unit, University Hospital of Lund, Lund, Sweden
| | - Karl Erik Edberg
- Department of Paediatric Intensive Care, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Claes Frostell
- Department of Anaesthesia and Intensive Care at Danderyd Hospital, Karolinska Institutet at Danderyd Hospital (KIDS), Stockholm, Sweden
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Kim MJ, Kim YH, Sol IS, Kim SY, Kim JD, Kim HY, Kim KW, Sohn MH, Kim KE. Serum anion gap at admission as a predictor of mortality in the pediatric intensive care unit. Sci Rep 2017; 7:1456. [PMID: 28469150 PMCID: PMC5431089 DOI: 10.1038/s41598-017-01681-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/31/2017] [Indexed: 01/27/2023] Open
Abstract
An accurate method to predict the mortality in the intensive care unit (ICU) patients has been required, especially in children. The aim of this study is to evaluate the value of serum anion gap (AG) for predicting mortality in pediatric ICU (PICU). We reviewed a data of 461 pediatric patients were collected on PICU admission. Corrected anion gap (cAG), the AG compensated for abnormal albumin levels, was significantly lower in survivors compared with nonsurvivors (p < 0.001). Multivariable logistic regression analysis identified the following variables as independent predictors of mortality; cAG (OR 1.110, 95% CI 1.06–1.17; p < 0.001), PIM3 [OR 7.583, 95% CI 1.81–31.78; p = 0.006], and PRISM III [OR 1.076, 95% CI 1.02–1.14; p = 0.008]. Comparing AUCs for mortality prediction, there were no statistically significant differences between cAG and other mortality prediction models; cAG 0.728, PIM2 0.779, PIM3 0.822, and PRISM III 0.808. The corporation of cAG to pre-existing mortality prediction models was significantly more accurate at predicting mortality than using any of these models alone. We concluded that cAG at ICU admission may be used to predict mortality in children, regardless of underlying etiology. And the incorporation of cAG to pre-existing mortality prediction models might improve predictability.
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Affiliation(s)
- Min Jung Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - In Suk Sol
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Deok Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
| | - Myung Hyun Sohn
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Earn Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Nyirasafari R, Corden MH, Karambizi AC, Kabayiza JC, Makuza JD, Wong R, Canarie MF. Predictors of mortality in a paediatric intensive care unit in Kigali, Rwanda. Paediatr Int Child Health 2017; 37:109-115. [PMID: 27922344 DOI: 10.1080/20469047.2016.1250031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The enormous burden of critical illness in resource-limited settings has led to a growing interest in paediatric critical care in these regions. However, published data on the practice of critical care and patient outcomes in these settings are scant. OBJECTIVE This study sought to identify risk factors associated with mortality in the newly established Paediatric Intensive Care Unit (PICU) at Kigali University Teaching Hospital (KUTH) in Rwanda and test the predictive ability of a newly devised mortality risk score, the modified PRISM (MP) score. METHODS All admissions to the PICU at KUTH from October 2012 to October 2014 were included. Demographic and physiological data on each patient were gathered and each was assigned a MP score. This prospective cross-sectional study examined the association between the characteristics and physiological status of these patients and mortality. Using logistic regression, factors associated with mortality in the PICU were analysed. RESULTS A total of 213 children were admitted to the PICU during the study period. Three patients were excluded because of missing data. Of this total, 59% were male, 25% were neonates and nearly 60% were moderately to severely malnourished. The overall mortality rate was 50%. On bivariate analysis, factors associated with increased mortality were male sex, use of vasoactive medications, a MP score ≥ 5, a discharge diagnosis of septic shock, and malnutrition on admission. On multivariate analysis, only the use of vasoactive drugs [odds ratio (OR) 12.24, 95% confidence interval (CI) 4.4-35.4, p < 0.001] and MP score ≥ 5 (OR 16.1, CI 6.3-40.8, p < 0.001) were associated with mortality. CONCLUSION The observed mortality rate was in the range reported in other resource-limited settings. The initial attempt to create and implement a risk of mortality tool for this setting determined a score that could identify those patients at higher risk of mortality. In PICUs in resource-limited settings, the gathering of data and use of severity of illness tools could improve care in a number of ways.
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Affiliation(s)
- Rosine Nyirasafari
- a Department of Pediatrics and Child Health , Ministry of Health, Rwamagana Provincial Hospital , Rwamagana , Rwanda
| | - Mark H Corden
- b Division of Hospital Medicine , Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California , Los Angeles , CA , USA
| | | | - Jean Claude Kabayiza
- d School of Medicine and Pharmacy, College of Medicine and Health Sciences , University of Rwanda , Butare , Rwanda
| | - Jean Damascene Makuza
- e STIs Care and Treatment Senior Office, HIV and STIs Division, Rwanda Biomedical Centre , Kigali , Rwanda
| | - Rex Wong
- f Yale University Global Health Leadership Institute , New Haven , CT , USA
| | - Michael F Canarie
- g Department of Pediatrics, Division of Critical Care , Yale University School of Medicine , New Haven , CT , USA
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HU L, ZHU Y, CHEN M, LI X, LU X, LIANG Y, TAN H. Development and Validation of a Disease Severity Scoring Model for Pediatric Sepsis. IRANIAN JOURNAL OF PUBLIC HEALTH 2016; 45:875-84. [PMID: 27516993 PMCID: PMC4980341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Multiple severity scoring systems have been devised and evaluated in adult sepsis, but a simplified scoring model for pediatric sepsis has not yet been developed. This study aimed to develop and validate a new scoring model to stratify the severity of pediatric sepsis, thus assisting the treatment of sepsis in children. METHODS Data from 634 consecutive patients who presented with sepsis at Children's hospital of Hunan province in China in 2011-2013 were analyzed, with 476 patients placed in training group and 158 patients in validation group. Stepwise discriminant analysis was used to develop the accurate discriminate model. A simplified scoring model was generated using weightings defined by the discriminate coefficients. The discriminant ability of the model was tested by receiver operating characteristic curves (ROC). RESULTS The discriminant analysis showed that prothrombin time, D-dimer, total bilirubin, serum total protein, uric acid, PaO2/FiO2 ratio, myoglobin were associated with severity of sepsis. These seven variables were assigned with values of 4, 3, 3, 4, 3, 3, 3 respectively based on the standardized discriminant coefficients. Patients with higher scores had higher risk of severe sepsis. The areas under ROC (AROC) were 0.836 for accurate discriminate model, and 0.825 for simplified scoring model in validation group. CONCLUSIONS The proposed disease severity scoring model for pediatric sepsis showed adequate discriminatory capacity and sufficient accuracy, which has important clinical significance in evaluating the severity of pediatric sepsis and predicting its progress.
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Affiliation(s)
- Li HU
- School of Public Health, Central South University, Changsha, P. R. China
| | - Yimin ZHU
- Institute of Emergency Medicine, People’s Hospital of Hunan Province, Changsha, P. R. China,Corresponding Author:
| | - Mengshi CHEN
- Pediatric Intensive Critical Unit, Children’s Hospital of Hunan Province, Changsha, P. R. China
| | - Xun LI
- School of Public Health, Central South University, Changsha, P. R. China
| | - Xiulan LU
- Pediatric Intensive Critical Unit, Children’s Hospital of Hunan Province, Changsha, P. R. China
| | - Ying LIANG
- School of Public Health, Central South University, Changsha, P. R. China
| | - Hongzhuan TAN
- School of Public Health, Central South University, Changsha, P. R. China,Corresponding Author:
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Pai S, Enoch DA, Aliyu SH. Bacteremia in children: epidemiology, clinical diagnosis and antibiotic treatment. Expert Rev Anti Infect Ther 2015; 13:1073-88. [PMID: 26143645 DOI: 10.1586/14787210.2015.1063418] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The diagnosis of bacteremia in children is important and it can be clinically challenging to recognize the signs and symptoms. The reported rates of bacteremia are higher in young children but with the increasing vaccine coverage, there has been a decrease in bacteremia due to the three vaccine preventable bacteria (Streptococcus pneumoniae, Haemophilus influenzae group b and Neisseria meningitidis). Notably, there have been increases in healthcare-associated bacteremias with a rise in Staphylococcus aureus and Gram negative bacteremias. This review provides a brief overview of the clinical diagnosis of bacteremia in children, focusing on the epidemiology, clinical characteristics, risk factors, antibiotic treatment, outcomes and preventative measures to reduce the incidence of bacteremia and improve morbidity and mortality.
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Affiliation(s)
- Sumita Pai
- Public Health England, Clinical Microbiology and Public Health Laboratory, Cambridge, UK
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27
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Wang G, Wang D, Jiang X, Yu X, Ma L, Zhong J, Feng X. Blood zinc, iron, and copper levels in critically ill neonates. Biol Trace Elem Res 2015; 164:8-11. [PMID: 25471202 DOI: 10.1007/s12011-014-0193-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 11/23/2014] [Indexed: 02/05/2023]
Abstract
The aim of this study is to explore the prognostic value of blood zinc, iron, and copper levels in critically ill neonates by comparing blood metal levels with the score for neonatal acute physiology (SNAP). Forty-six neonates (26 boys, 20 girls; ages ranging from 10 min to 23 days) who had been admitted to the neonatal intensive care unit of hospital and who were critically ill according to SNAP were included. Another 15 neonates (12 boys, 8 girls; ages ranging from 30 min to 24 days) who were brought to the hospital for a health checkup were included as controls. Clinical data, time in the intensive care unit, prognosis, and SNAP for critically ill neonates were recorded. Blood Cu, Zn, and Fe values were measured by inductively coupled plasma atomic emission spectrophotometry. Ill neonates were divided into extremely critical (SNAP ≥ 10) and critical groups (1 ≤ SNAP < 9). Zn levels were lower in patients than in controls (p <0.05). Cu levels did not differ between patients and controls (p >0.05). Fe levels were not significantly between the critical and control groups (p >0.05). In ill neonates, blood Zn and Fe concentrations in the extremely critical group were lower than in the critical group (p <0.05). Serious illness in neonates may lead to decreased Zn and Fe blood concentrations. Zn and Fe supplements may be beneficial for critically ill children.
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Affiliation(s)
- Guanghuan Wang
- The Second Affiliated Hospital, Shantou University Medical College, Shantou City, 515041, Guangdong Province, People's Republic of China
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Rady HI, Mohamed SA, Mohssen NA, ElBaz M. Application of different scoring systems and their value in pediatric intensive care unit. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2014. [DOI: 10.1016/j.epag.2014.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bekhit OESM, Algameel AA, Eldash HH. Application of pediatric index of mortality version 2: score in pediatric intensive care unit in an African developing country. Pan Afr Med J 2014; 17:185. [PMID: 25396011 PMCID: PMC4229007 DOI: 10.11604/pamj.2014.17.185.2818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 12/28/2013] [Indexed: 11/19/2022] Open
Abstract
Introduction Outcome of patients admitted to PICU can be evaluated by many illness severity scoring systems. This prospective observational study evaluated the outcome of patients admitted to PICU in Fayoum University hospital of a developing country using the pediatric index of mortality version 2 scoring system. Methods All patients included in this study were subjected to data collection including demographics, diagnoses at admission, duration of ICU stay (DOS), pediatric index of mortality version 2 (PIM2) score and hospital outcome. The ratio of observed to predicted mortality (standardized mortality ratio (SMR)) was calculated for the set of patients. Results The study included 205 patients. The main causes of admission were respiratory, cardiovascular and neurological illnesses. Patients stay in ICU ranged from 1 - 45 days with a median 6 (interquartile range (IQ): 3-9) days. Discriminatory function of PIM2 scoring system was acceptable with the area under the ROC curve 0.76 (95%CI: 0.60-0.91). PIM2 calibrated well using Hosmer Lemeshow analysis (H-L X2= 1.410, df= 8, p=0.9). The mean predicted mortality was 5.6 (95% CI: 3.43 - 7.91) and the observed mortality was 8.8% giving a SMR 1.55. Conclusion PIM2 scoring system show adequate discriminatory function and well calibrated for the case mix of patients in PICU of Fayoum, Egypt. It can be used as beneficial tool for evaluation of risk adjusted mortality. Further larger scale studies in cooperation with other Egyptian universities and neighboring countries can improve the performance of our PICUs and critical care services.
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Affiliation(s)
| | | | - Hanaa Hasan Eldash
- Pediatrics Department, Faculty of Medicine, Al Fayoum University, Al Fayoum, Egypt
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Abstract
BACKGROUND Sepsis and septic shock represent up to 30% of admitted patients in pediatric intensive care units, with a mortality that can exceed 10%. The objective of this study is to determine the prognostic factors for mortality in sepsis. METHODS Multicenter prospective descriptive study with patients (aged 7 days to 18 years) admitted to the pediatric intensive care units for sepsis, between January 2011 and April 2012. RESULTS Data from 136 patients were collected. Eighty-seven were male (63.9%). The median age was a year and a half (P25-75 0.3-5.5 years). In 41 cases (30.1%), there were underlying diseases. The most common etiology was Neisseria meningitidis (31 cases, 22.8%) followed by Streptococcus pneumoniae (16 patients, 11.8%). Seventeen cases were fatal (12.5%). In the statistical analysis, the factors associated with mortality were nosocomial infection (P = 0.004), hypotension (P <0.001) and heart and kidney failure (P < 0.001 and P = 0.004, respectively). The numbers of leukocytes, neutrophils and platelets on admission were statistically lower in the group that died (P was 0.006, 0.013 and <0.001, respectively). Multivariate analysis showed that multiple organ failure, neutropenia, purpura or coagulopathy and nosocomial infection were independent risk factors for increased mortality (odds ratio: 17, 4.9, 9 and 9.2, respectively). CONCLUSIONS Patients with sepsis and multiorgan failure, especially those with nosocomial infection or the presence of neutropenia or purpura, have a worse prognosis and should be monitored and treated early.
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Wang G, Feng X, Yu X, Xu X, Wang D, Yang H, Shi X. Prognostic value of blood zinc, iron, and copper levels in critically ill children with pediatric risk of mortality score III. Biol Trace Elem Res 2013; 152:300-4. [PMID: 23389847 DOI: 10.1007/s12011-013-9623-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 01/29/2013] [Indexed: 02/05/2023]
Abstract
We aimed to explore the association of blood Zn, Fe, and Cu concentrations and changes in the pediatric risk of mortality (PRISM) score in critically ill children, to predict prognosis. We included 31 children (22 boys and 9 girls, 1 month to 5 years old), who had been admitted to the intensive care unit of our hospital and who were critically ill according to PRISM score of III. Another 20 children (12 boys, 8 girls, 3 months to 5 years old) who were brought to the hospital for a health checkup were included as controls. We recorded clinical data, time in the intensive care unit, prognosis, and PRISM III score for critically ill children. Blood Cu, Zn, and Fe values were measured by inductively coupled plasma atomic emission spectrophotometry. Zn and Fe levels were significantly lower in patients than in controls (all p < 0.05). Cu levels differed between patients and controls, but not significantly (p > 0.05). In ill children, blood Zn and Fe concentrations were inversely correlated with PRISM III score (Zn: r = -0.36; Fe: r = -0.50, both p < 0.05), with no significant correlation of blood Cu level and PRISM III score (r = -0.13, p > 0.05). Serious illness in children may lead to decreased Zn and Fe blood concentrations. Zn and Fe supplements may be beneficial for critically ill children.
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Affiliation(s)
- Guanghuan Wang
- Department of Forensic Medicine, Shantou University Medical College, Shantou, 515041, Guangdong Province, People's Republic of China
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Badia M, Vicario E, García-Solanes L, Serviá L, Justes M, Trujillano J. Atención del paciente crítico pediátrico en una UCI de adultos. Utilidad del índice PIM. Med Intensiva 2013; 37:83-90. [DOI: 10.1016/j.medin.2012.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 01/08/2012] [Accepted: 03/03/2012] [Indexed: 11/15/2022]
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Rocha-e-Silva M. Molecular and genetic aspects of oncology and infectology in Clinics. Clinics (Sao Paulo) 2012; 67:1353-6. [PMID: 23295585 PMCID: PMC3521794 DOI: 10.6061/clinics/2012(12)01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Zamberlan P, Leone C, Tannuri U, Carvalho WBD, Delgado AF. Nutritional risk and anthropometric evaluation in pediatric liver transplantation. Clinics (Sao Paulo) 2012; 67:1387-92. [PMID: 23295591 PMCID: PMC3521800 DOI: 10.6061/clinics/2012(12)07] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/06/2012] [Accepted: 08/14/2012] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To analyze the nutritional status of pediatric patients after orthotopic liver transplantation and the relationship with short-term clinical outcome. METHOD Anthropometric evaluations of 60 children and adolescents after orthotopic liver transplantation, during the first 24 hours in a tertiary pediatric intensive care unit. Nutritional status was determined from the Z score for the following indices: weight/age height/age or length/age, weight/height or weight/length, body mass index/age, arm circumference/age and triceps skinfold/age. The severity of liver disease was evaluated using one of the two models which was adequated to the patients' age: 1. Pediatric End-stage Liver Disease, 2. Model for End-Stage Liver Disease. RESULTS We found 50.0% undernutrition by height/age; 27.3% by weight/age; 11.1% by weight/height or weight/ length; 10.0% by body mass index/age; 61.6% by arm circumference/age and 51.0% by triceps skinfold/age. There was no correlation between nutritional status and Pediatric End-stage Liver Disease or mortality. We found a negative correlation between arm circumference/age and length of hospitalization. CONCLUSION Children with chronic liver diseases experience a significant degree of undernutrition, which makes nutritional support an important aspect of therapy. Despite the difficulties in assessment, anthropometric evaluation of the upper limbs is useful to evaluate nutritional status of children before or after liver transplantation.
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Affiliation(s)
- Patrícia Zamberlan
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto da Criança, São Paulo/SP, Brazil.
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Gomes AM, Higa DA. Pulmonary research recently published in Brazilian journals. J Bras Pneumol 2012; 38:634-42. [PMID: 23147057 DOI: 10.1590/s1806-37132012000500014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 09/14/2012] [Indexed: 11/22/2022] Open
Abstract
We reviewed original articles in the field of pulmonary medicine that had been recently published in 12 Brazilian journals--general or specialty journals--excluding the Brazilian Journal of Pulmonology. All were journals indexed for the Institute for Scientific Information Web of Knowledge. The selection of articles was based on the "continuously variable rating" concept. We have organized the articles by category.
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Rocha e Silva M. Pneumological research in Clinics. Clinics (Sao Paulo) 2012; 67. [PMID: 23184196 PMCID: PMC3488978 DOI: 10.6061/clinics/2012(11)02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Rocha e Silva M. Pediatrics in Clinics: highlights. Clinics (Sao Paulo) 2012; 67:859-64. [PMID: 22948450 PMCID: PMC3416888 DOI: 10.6061/clinics/2012(08)01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Tamma PD, Turnbull AE, Milstone AM, Hsu AJ, Carroll KC, Cosgrove SE. Does the piperacillin minimum inhibitory concentration for Pseudomonas aeruginosa influence clinical outcomes of children with pseudomonal bacteremia? Clin Infect Dis 2012; 55:799-806. [PMID: 22696019 DOI: 10.1093/cid/cis545] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The Clinical and Laboratory Standards Institute (CLSI) recently elected to adjust the previous piperacillin susceptibility breakpoint of ≤64 µg/mL against Pseudomonas aeruginosa to ≤16 µg/mL, based largely on pharmacokinetic-pharmacodynamic (PK-PD) modeling studies. Data on whether PK-PD modeling correlates with clinical outcomes in children are needed before resorting to broader classes of antibiotics to treat P. aeruginosa. METHODS We performed a retrospective cohort study of children with P. aeruginosa bacteremia between 2001 and 2010 who were prescribed piperacillin. Baseline characteristics and clinical outcomes of children with piperacillin minimum inhibitory concentrations (MICs) of ≤16 µg/mL and of 32-64 µg/mL were compared. The primary outcome was 30-day mortality. RESULTS There were 170 children with P. aeruginosa bacteremia receiving piperacillin therapy who met inclusion criteria. One hundred twenty-four (72%) children had piperacillin MICs of ≤16 µg/mL and 46 (28%) children had piperacillin MICs of 32-64 µg/mL. There was no significant difference in baseline characteristics between the 2 groups. Thirty-day mortality was 9% and 24% in children with a piperacillin MIC of ≤16 µg/mL and of 32-64 µg/mL, respectively. Using multivariable logistic regression, children with elevated MICs had increased odds of mortality compared with children with lower MICs (odds ratio, 3.21; 95% confidence interval, 1.26-8.16). CONCLUSIONS Our finding that elevated piperacillin MICs are associated with higher mortality in children supports the recent CLSI recommendation to lower the breakpoint of piperacillin against P. aeruginosa to ≤16 µg/mL. Alternate therapeutic choices should be considered when piperacillin MICs against P. aeruginosa are ≥32 µg/mL.
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Affiliation(s)
- Pranita D Tamma
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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