Use of Transport Illness Severity Scores To Predict Risk Of Clinical Deterioration In Transported Patients

2021 ◽  
Author(s):  
Carly Schmidt ◽  
Alexis Thompson ◽  
Sarah S. Welsh ◽  
Ranna Rozenfeld
Keyword(s):  
Illness Severity ◽  
Clinical Deterioration ◽  
Severity Scores

1048: Predicting Clinical Deterioration in Pediatric Patients With Transport Illness Severity Scores

2020 ◽  
Vol 49 (1) ◽  
pp. 524-524
Author(s):  
Carly Schmidt ◽  
Alexis Thompson ◽  
Sarah Welsh ◽  
Darlene Simas ◽  
Patricia Carreiro ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Illness Severity ◽  
Clinical Deterioration ◽  
Severity Scores

scholarly journals Angiopoietin 2 Levels in the Risk Stratification and Mortality Outcome Prediction of Sepsis-Associated Coagulopathy

2018 ◽  
Vol 24 (8) ◽  
pp. 1223-1233 ◽  
Author(s):  
Stephen Statz ◽  
Giselle Sabal ◽  
Amanda Walborn ◽  
Mark Williams ◽  
Debra Hoppensteadt ◽  
...  
Keyword(s):  
Plasma Levels ◽  
Predictive Biomarker ◽  
Illness Severity ◽  
Assay Method ◽  
Enzyme Linked Immunosorbent Assay ◽  
Icu Admission ◽  
Severity Scores ◽  
Mortality Outcome ◽  
Clinical Illness ◽  
Angiopoietin 2

It has been well established that angiopoietin 2 (Ang-2), a glycoprotein involved in activation of the endothelium, plays an integral role in the pathophysiology of sepsis and many other inflammatory conditions. However, the role of Ang-2 in sepsis-associated coagulopathy (SAC) specifically has not been defined. The aim of this study was to measure Ang-2 plasma levels in patients with sepsis and suspected disseminated intravascular coagulation (DIC) in order to demonstrate its predictive value in SAC severity determination and 28-day mortality outcome. Plasma samples were collected from 102 patients with sepsis and suspected DIC at intensive care unit (ICU) admission. The Ang-2 plasma levels were quantified using a sandwich enzyme-linked immunosorbent assay method. The International Society on Thrombosis and Haemostasis DIC scoring system was used to compare the accuracy of Ang-2 levels versus clinical illness severity scores in predicting SAC severity. Mean Ang-2 levels in patients with sepsis and DIC were significantly higher in comparison to healthy controls ( P < 0.0001), and median Ang-2 levels showed a downward trend over time ( P = 0.0008). Baseline Ang-2 levels and clinical illness severity scores were higher with increasing severity of disease, and Ang-2 was a better predictor of DIC severity than clinical illness scores. This study demonstrates that Ang-2 levels are significantly upregulated in SAC, and this biomarker can be used to risk stratify patients with sepsis into non-overt DIC and overt DIC. Furthermore, the Ang-2 level at ICU admission in a patient with sepsis and suspected DIC may provide a predictive biomarker for mortality outcome.

Simple translational equations to compare illness severity scores in intensive care trials

2013 ◽  
Vol 28 (5) ◽  
pp. 885.e1-885.e8 ◽  
Author(s):  
Antoine G. Schneider ◽  
Miklós Lipcsey ◽  
Michael Bailey ◽  
David V. Pilcher ◽  
Rinaldo Bellomo
Keyword(s):  
Intensive Care ◽  
Illness Severity ◽  
Severity Scores

scholarly journals Family-Assisted Severity of Illness Monitoring for Hospitalized Children in Low-resource settings – a two-arm interventional pilot study

2021 ◽  
Author(s):  
Amelie O. von Saint Andre-von Arnim ◽  
Rashmi K. Kumar ◽  
Jonna D. Clark ◽  
Benjamin S. Wilfond ◽  
Quynh-Uyen P. Nguyen ◽  
...  
Keyword(s):  
Pilot Study ◽  
Severity Of Illness ◽  
Febrile Illness ◽  
Illness Severity ◽  
Clinical Deterioration ◽  
Hospitalized Children ◽  
Low Resource Settings ◽  
Low Resource ◽  
Link Type ◽  
Sick Children

AbstractIntroductionPediatric mortality remains unacceptably high in many low-resource settings, with inpatient deaths often associated with delayed recognition of clinical deterioration. The Family-Assisted Severe Febrile Illness ThERapy (FASTER) tool has been developed for caregivers to assist in monitoring their hospitalized children and alert clinicians. While utilization of the tool is feasible, the impact on outcomes in low-resource settings has not been studied.MethodsRandomized controlled pilot study at Kenyatta National Hospital, Kenya. Children hospitalized with acute febrile illness with a caregiver at the bedside for 24 hours were enrolled. Caregivers were trained using the FASTER tool (monitors work of breathing, mental status, perfusion, producing color-coded flags to signal illness severity). The primary outcome was the frequency of clinician reassessments between intervention (FASTER) and control (standard care) arms. Secondary outcomes included survey assessments of clinician and caregiver experiences with the tool. The study was registered with ClinicalTrials.govNCT03513861.Results150 patient/caregiver pairs were enrolled, 139 included in the analysis, 74 in the intervention, 65 in the control arm. Patients’ median age was 0.9 (range 0.2-10) and 1.1 years (range 0.2-12) in intervention versus control arms. The most common diagnoses were pneumonia (80[58%]), meningitis (58[38%]) and malaria (34[24%]). 134(96%) caregivers were patients’ mothers. Clinician visits/hour increased with patients’ illness severity in both arms, but without difference in frequency between arms (point estimate for the difference -0.2%, p=0.99). Of the 16 deaths, 8 (four/arm) occurred within 2 days of enrollment. Forty clinicians were surveyed, 33(82%) reporting that FASTER could improve outcomes of very sick children in low-resource settings; 26(65%) rating caregivers as able to adequately capture patients’ severity of illness. Of 70 caregivers surveyed, 63(90%) reported that FASTER training was easy to understand; all(100%) agreed that the intervention would improve care of hospitalized children and help identify sick children in their community.DiscussionAlthough we observed no difference in recorded frequency of clinician visits with FASTER monitoring, the tool was rated positively by caregivers and clinicians. Further research to refine implementation with additional input from all stakeholders might increase the effectiveness of FASTER in detecting and responding to clinical deterioration in low-resource settings.

Interrater Reliability of APACHE II Scores for Medical-Surgical Intensive Care Patients: A Prospective Blinded Study

2007 ◽  
Vol 16 (4) ◽  
pp. 378-383 ◽  
Author(s):  
Michelle E. Kho ◽  
Ellen McDonald ◽  
Paul W. Stratford ◽  
Deborah J. Cook
Keyword(s):  
Intensive Care ◽  
Interrater Reliability ◽  
Intraclass Correlation ◽  
Illness Severity ◽  
Apache Ii ◽  
Surgical Intensive Care Unit ◽  
Apache Ii Score ◽  
Surgical Intensive Care ◽  
Chronic Health ◽  
Severity Scores

Background Despite widespread use of the Acute Physiology and Chronic Health Evaluation II (APACHE II), its interrater reliability has not been well studied. Objective To determine interrater reliability of APACHE II scores among 1 intensive care nurse and 2 research clerks. Methods In a prospective, blinded, observational study, 3 raters collected APACHE II scores on 37 consecutive patients in a medical-surgical intensive care unit. One research clerk was blinded to the study’s start date to minimize observer bias. The nurse and the other research clerk were blinded to each other’s scores and did not communicate with the first research clerk about the study. The data analyst was blinded to the identity and source of all 3 raters’ scores. Intraclass correlation coefficients and 95% confidence intervals were assessed. Results Mean (standard deviation) APACHE II scores were 21.8 (9.2) for the nurse, 20.4 (7.7) for research clerk 1, and 20.5 (8.1) for research clerk 2. Among the 3 raters, the intraclass correlation coefficient (95% confidence interval) was 0.90 (0.84, 0.94) for the APACHE II total score. Within APACHE II score components, the highest reliability was for age (0.98 [0.97, 0.99]), with lower reliabilities for the Chronic Health Index (0.64 [0.50, 0.80]) and the verbal component of the Glasgow Coma Scale (0.40 [0.20, 0.60]). Results were similar between pairs of raters. Conclusions Use of trained nonmedical personnel to collect illness severity scores for clinical, research, and administrative purposes is reasonable. This method could be used to assess reliability of other illness severity scores.

Effects of two dosing regimens of intravenous ranitidine on gastric pH in critically ill children

1994 ◽  
Vol 3 (4) ◽  
pp. 267-272 ◽  
Author(s):  
JL Osteyee ◽  
W Banner
Keyword(s):  
Continuous Infusion ◽  
Critically Ill ◽  
Illness Severity ◽  
Gastric Ph ◽  
Critically Ill Children ◽  
Gastric Bleeding ◽  
Ph Values ◽  
Severity Scores ◽  
Study Results ◽  
Significant Difference

BACKGROUND: Gastric bleeding in children is associated with critical illness, shock, and physical trauma. Histamine-2 receptor antagonist therapy is used prophylactically to treat gastric bleeding, but it is not known whether bolus dosing or continuous infusion dosing is more effective. OBJECTIVES: To compare the effects of continuous infusion intravenous ranitidine and intravenous bolus dosing of ranitidine on gastric pH in critically ill children and to look for correlation between illness severity scores and gastric pH. METHODS: Sixteen critically ill children were randomized into two groups. Children in group 1 received bolus dosing on day 1 and continuous infusion of ranitidine on day 2. Group 2 received the continuous infusion on day 1 and bolus dosing on day 2. Equivalent doses of ranitidine were based on weight. Continuous infusion regimen: ranitidine bolus of 0.15 mg/kg followed by continuous infusion at 0.15 mg/kg per hour for 12 hours. Bolus regimen: 1 mg/kg, two doses 6 hours apart. Pediatric risk of mortality scores were recorded upon admission to the study. RESULTS: There was no statistically significant difference between regimens. Both raised gastric pH values above 4.0 during the treatment phase. There was no correlation between illness severity scores and gastric pH values. CONCLUSIONS: Both bolus dosing and continuous infusion dosing of 4 mg/kg per day of intravenous ranitidine were effective at raising and maintaining gastric pH in critically ill children.

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