Author Reply - SOFA-based Prognostication in PICU: A Cardiovascular Critique!

How to cite this article: Lois A, Save S. Author Reply - SOFA-based Prognostication in PICU: A Cardiovascular Critique! Indian J Crit Care Med 2023;27(11):863.

Serial Evaluation of Sequential Organ Failure Assessment Score (SOFA) as a Predictor of Outcome in Children Admitted in Pediatric Intensive Care Unit (PICU) at Tertiary Care Hospital

Background

Sequential organ failure assessment score (SOFA) is a score to quantify organ system dysfunction. This study was done to evaluate SOFA as a predictor of outcomes in children in pediatric intensive care unit (PICU).

Objective

(A) To determine whether initial SOFA, Delta SOFA, and SOFA score at 72 hours are better predictors of outcome in terms of sensitivity and specificity. (B) To compare the initial SOFA, Delta SOFA, and SOFA score at 72 hours.

Materials and methods

A prospective observational study was conducted on 160 patients aged from 29 days to 12 years admitted in PICU of a Tertiary Care Hospital in a metropolitan city in India for a period of 1 year. Then, the initial SOFA score, 72-hour SOFA, and Delta SOFA (T0 SOFA - T72 SOFA) were calculated and patients were followed up till discharge from PICU or deceased.

Results

The best threshold to differentiate between discharged and deceased corresponds to as initial SOFA of 7.50 with a sensitivity of 64.71%, and specificity of 89.51%. The similar threshold for 72 hours SOFA is 10.50 which correspond to a sensitivity of 76.47% and specificity of 96.50%. The study showed strong evidence (p-value < 0.05) that, patients whose Delta SOFA values increased from the previous value (-1.5), had a greater chance to succumb to illness. Delta SOFA had the best sensitivity (82.35%) and 72-hour SOFA had the best specificity (96.50%) in predicting the outcome of PICU patients.

Conclusion

This study emphasizes the use of SOFA score as a prognostic indicator in critically ill children, as variables measured are easily available.

How to cite this article

Lois A, Save S. Serial Evaluation of Sequential Organ Failure Assessment Score (SOFA) as a Predictor of Outcome in Children Admitted in Pediatric Intensive Care Unit (PICU) at Tertiary Care Hospital. Indian J Crit Care Med 2023;27(8):590-595.

Clinical characteristics & severity profile of children with COVID-19 during the second wave pandemic: An experience from tertiary care hospital in Mumbai

This retrospective observational study was aimed at defining the demographic and clinical characteristics as well as severity profile of COVID-19 disease in children admitted to dedicated COVID-19 tertiary care hospital in Mumbai, India, during the second wave. COVID-19 infection detected in children (1 month-12 years) by the rapid antigen test or reverse transcriptase polymerase chain reaction or TRUENAT from March 1 to July 31, 2021 on throat/nasopharyngeal samples were enrolled and their clinical features and outcomes were studied. During the study period, 77 children with COVID-19 infection were admitted, of whom two-third (59.7%) were <5 yr old. The common presenting symptom was fever (77%), followed by respiratory distress. Comorbidities were noted in 34 (44.2%) children. Most of the patients belonged to the mild severity category (41.55%). While 25.97 per cent of patients presented in severe category and 19.48 per cent were asymptomatic. Admission to intensive care was needed in 20 (25.9%) patients, with 13 patients needing invasive ventilation. Nine patients succumbed while 68 were discharged. The results might help understand the course, severity profile and outcomes of the second wave of the COVID-19 pandemic in the paediatric population.

DREEM Study: Students Perceptions of Learning Environment in a Medical College in Mumbai, India

PURPOSE

This study was carried out to assess medical education environment (MEE) at our institution and to determine if there is an association between the assessment scores and factors such as gender, residence, family educational background and medium of instruction during school years.

METHODS

Students appearing for the final qualifying examination were enrolled in the cross-sectional survey after obtaining written informed consent. Demographic data and personal information such as place of residence, parental education and medium of instruction was collected. The Dundee Ready Education Environment Measure (DREEM) Questionnaire was used for assessment of MEE. The numerical variables were described in terms of mean and standard deviation, median and inter-quartile range and percentages. Independent t-test, one-way Anova, Mann-Whitney test and Kruskall- Wallis test were the analytical tests used depending upon the number of groups and characteristics of the data.

RESULTS

Fifty-five students were enrolled in the study. The overall DREEM score was 119+/-22 (Median 116), 46(83.64%) reported overall positive perception). Students' perception of atmosphere (SPA) scored highest as compared to other domains. Teacher-centered teaching with emphasis on factual learning, authoritarian teachers, boredom in the course and lacking support systems were some of the problem areas identified on the basis of students' perceptions. There was a significant difference in Students' academic self-perception (SASP) and students' social self-perception scores between students coming from urban and rural backgrounds.

CONCLUSIONS

Students reported an overall positive perception of MEE. Problem areas and research priorities were identified leading to a preparation of an action plan.

Choosing the Right Journal for a Scientific Paper

Authors need to take the crucial decision of choosing the journal for their prospective manuscript before even starting to write it. Although, this choice is influenced by many factors, matching the intended recipients of the main message of the manuscript with a journal's readership should override all other consideration in journal selection. That done, availability of time-bound review process,journal's visibility, indexation in databases, regularity of publication, acceptance rate and expenses involved are some other factors that will help decide the choice.

Writing Case Reports: Contributing to Practice and Research

Case reports describe a patient with unusual or unexpected features. They represent the oldest type of medical publication. They are about generating a new hypothesis and not about proving a hypothesis. Hence, despite being considered as the lowest level of evidence; they continue to be relevant for clinical practice, research and medical education. This article intends to provide guidance regarding writing a case report to those wishing to make a foray in scientific writing through reporting an interesting case.

A study to evaluate the antimicrobial activity of feracrylum and its comparison with povidone-iodine

Feracrylum, a water-soluble polymer of polyacrylic acid is known for its hemostatic property. Present work is an effort to evaluate its minimum inhibitory concentration (MIC) and compare it with the MIC of povidone-iodine. Ten different species of pathogenic microorganisms were selected, strains of which were obtained from Haffkine Institute. The organisms were maintained under appropriate culture media. The MIC of Freracrylum was determined by using tube culture method where its activity was compared against a standard antimicrobial agent providone-iodine. The study parameters showed that Feracrylum exhibits antimicrobial activity against a wide variety of microorganisms and its efficacy is comparable to that of povidone-iodine.