Neonatal Therapeutic Intervention Scoring System: A Therapy-Based Severity-of-Illness Index

PEDIATRICS ◽  
1992 ◽  
Vol 90 (4) ◽  
pp. 561-567 ◽  
Author(s):  
James E. Gray ◽  
Douglas K. Richardson ◽  
Marie C. McCormick ◽  
Kathryn Workman-Daniels ◽  
Donald A. Goldmann
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Therapeutic Intervention ◽  
Scoring System ◽  
Neonatal Intensive Care ◽  
Severity Of Illness Index ◽  
Severity Of Illness ◽  
Illness Severity ◽  
Hospital Charges ◽  
Therapeutic Intervention Scoring System

Severity-of-illness scales have proven valuable able in assessing clinical outcomes and resource consumption in adult and pediatric intensive care, but they have been less extensively developed for neonatal care. The National Therapeutic Intervention Scoring System (NTISS) was created by modifying the Therapeutic Intervention Scoring System (TISS). From the 76 original TISS items, 42 were deleted and 28 added to form the NTISS. Like TISS, NTISS assigns score points from 1 to 4 for various intensive care therapies. Admission-day NTISS scores were calculated for 1643 newborns admitted to three neonatal intensive care units (NICUs) between November 1, 1989, and September 30, 1990. NTISS scores ranged from 0 to 47 with a mean of 12.3 ± 8.7 (SD). There was little correlation with birth weight (r = -.11) or gestational age (r = -.17), but NTISS scores were highly correlated with expected markers of illness severity, including mortality risk estimates by neonatal attending physicians (r = .70, P < .0001), in-hospital mortality rates (P < .05), and a measure of nursing acuity (Medicus) (r = .05), and a measure of nursing acuity (Medicus) (r = .69, P < .0001). In addition, admission-day NTISS scores were found to be predictive of both NICU length of stay (r = .37, P < .0001) and total hospital charges for survivors (r = .65, P < .0001). It is concluded that NTISS is a valid measure of therapeutic intensity that is independent of birth weight and can be used as an indicator of neonatal illness severity and resource utilization. Further validation in other NICUs is required.

Monitoring Patients in Pediatric Intensive Care

PEDIATRICS ◽  
1985 ◽  
Vol 76 (5) ◽  
pp. 719-724
Author(s):  
Murray M. Pollack ◽  
Urs E. Ruttimann ◽  
Nancy L. Glass ◽  
Timothy S. Yeh
Keyword(s):  
Intensive Care ◽  
Therapeutic Intervention ◽  
Scoring System ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Stability Index ◽  
Routine Care ◽  
Therapeutic Intervention Scoring System ◽  
Monitoring Group ◽  
Bed Days

All admissions to a 16-bed multidisciplinary pediatric intensive care unit (PICU) were evaluated during two time periods totaling 13.5 months. Daily evaluations of therapeutic and monitoring care modalities were accomplished with the Therapeutic Intervention Scoring System (TISS) and daily assessments of severity of illness were done by using the Physiologic Stability Index. Of the 822 patients included in this study, 226 (27.5%) never received a therapy that could only be given in the PICU. These patients were known as the monitoring group and used 7.5% (297/3,969) of the bed days. The percentage of Therapeutic Intervention Scoring System points used by the monitoring patients was 3.6% (3,575/100,109). All patients who were monitored survived; 213 (94.2%) were classified as low mortality risk based on their level of physiologic stability. These data indicate that a significant percentage of PICU patients never receive a therapy that requires the PICU but only receive monitoring and routine care techniques. Significant reductions in PICU use could occur with more efficient usage.

scholarly journals A Tool for Calculating the Nursing Staff at Neonatal Intensive Care Units.

Aquichan ◽  
2011 ◽  
Vol 11 (2) ◽  
pp. 126-139 ◽  
Author(s):  
Juan Guillermo Rojas ◽  
Natalia Andrea Henao-Murillo ◽  
Alexandra Quirós-Jaramillo
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Nursing Staff ◽  
Therapeutic Intervention ◽  
Scoring System ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Therapeutic Intervention Scoring System

La gestión del cuidado de enfermería supone la utilización de métodos y herramientas que de manera práctica permitan una aproximación a las necesidades de cuidado de los pacientes y ayuden a planear los requerimientos humanos y técnicos para tal fin. Objetivo: identificar la utilidad del Neonatal Therapeutic Intervention Scoring System (NTISS) en el cálculo de personal de enfermería en la unidad de cuidado intensivo (UCIN) e intermedio neonatal (UCEN) de la Clínica Universitaria Bolivariana (CUB) en Medellín, Colombia. Método: estudio descriptivo, transversal, realizado durante el mes de abril de 2007. La población estuvo conformada por los neonatos ingresados y hospitalizados en la UCIN y UCEN, para lo que fue necesario aplicar el instrumento al final de cada turno. Se calculó una muestra de 384 instrumentos (proporción desconocida y un intervalo de confianza de 0,5). La consistencia interna del instrumento se determinó con el alfa de Cronbach (0,8). Resultados: se recolectaron 425 instrumentos diligenciados de 22 neonatos. Las patologías más frecuentes fueron las de tipo respiratorio. El puntaje total de los NTISS analizados fue de 5.200 puntos, con un promedio de 12,3, equivalentes a 123 minutos de trabajo de enfermería por turno de 6 horas. Del total de intervenciones el 62% están asignadas a las enfermeras, el 22% a las auxiliares de enfermería y el 16% a terapia respiratoria. Se calculó el requerimiento de 4 enfermeras por turno en la UCIN y UCEN. Conclusiones: el NTISS es útil para la asignación y el cálculo del personal de enfermería y contribuye a mejorar los procesos de gestión del cuidado.

Score for Neonatal Acute Physiology: Validation in Three Kaiser Permanente Neonatal Intensive Care Units

PEDIATRICS ◽  
1995 ◽  
Vol 96 (5) ◽  
pp. 918-922 ◽  
Author(s):  
Gabriel J. Escobar ◽  
Allen Fischer ◽  
De Kun Li ◽  
Robert Kremers ◽  
Mary Anne Armstrong
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Hospital Mortality ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Severity Of Illness ◽  
Predictive Ability ◽  
Neonatal Intensive Care Units ◽  
Total Hospital ◽  
Total Hospital Stay

Background. Measurement of the severity of illness is a research area of growing importance in neonatal intensive care. Most severity of illness scales have been developed in tertiary care settings. Their applicability in community neonatal intensive care units has not been tested. Objectives. Our goal was to assess the operational characteristics of the score for neonatal acute physiology (SNAP): the relationship to birth weight, the length of total hospital stay, and in-hospital mortality. Methods. We assigned SNAP scores prospectively to all inborn admissions at three community neonatal intensive care units during an 11-month period. Data on other neonatal predictors (eg, birth weight and the presence of congenital heart disease) were also collected. We measured in-hospital mortality, the experience of interhospital transport to a higher level of care, and total hospital stay. Results. We found that the SNAP's relationship to birth weight was similar to previous reports. The SNAP's perinatal extension is a reliable predictor of newborn in-hospital mortality, with an area under the receiver operator characteristic curve of 0.95. The SNAP is also a good predictor of total hospital length of stay, whether by itself (by which it can explain 31% of the total stay) or in combination with other variables. Its predictive ability is better among infants of low birth weight (<2500 g) than among those of normal birth weight (≥2500 g). The SNAP's predictive power was most limited among infants admitted to rule out sepsis. The predictive ability of a model containing birth weight, the SNAP, and transport status was not improved by the inclusion of two major diagnostic categories, the presence of congenital heart disease or complex illness. Conclusion. Although it has definite limitations among infants who weigh 2500 g or more, the SNAP is a potent tool for outcomes research. Modification of some of its parameters could result in a multifunctional scale suitable for use with all birth weights.

Coagulase-Negative Staphylococcal Bacteremia Among Very Low Birth Weight Infants: Relation to Admission Illness Severity, Resource Use, and Outcome

PEDIATRICS ◽  
1995 ◽  
Vol 95 (2) ◽  
pp. 225-230 ◽  
Author(s):  
James E. Gray ◽  
Douglas K. Richardson ◽  
Marie C. McCormick ◽  
Donald A. Goldmann
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Resource Use ◽  
Cumulative Incidence ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Illness Severity ◽  
Incidence Density ◽  
Low Birth Weight Infants

Objective. To examine the impact of admission-day illness severity on nosocomial bacteremia risk after consideration of traditional risk determinants such as birth weight and length of stay. Methods. The hospital courses for 302 consecutive very low birth weight (less than 1500 g) infants admitted to two neonatal intensive care units were examined for the occurrence of nosocomial coagulase-negative staphylococcal bacteremia. Using both cumulative incidence and incidence density as measures of bacteremia risk, we explored the relation between illness severity (as measured by the Score for Neonatal Acute Physiology [SNAP]) and bacteremia both before and after birth weight adjustment. In addition, the effect of bacteremia on hospital resource use was estimated. Results. Coagulase-negative staphylococcus was the most common pathogen noted in blood cultures drawn at 48 hours after admission or later. It was isolated on at least one occasion in 53 patients (cumulative incidence of 17.5 first episodes per 100 patients). These episodes occurred during 7652 days at risk, giving an incidence density of 6.9 initial bacteremias per 1000 patient-days at risk. As expected, when compared with the nonbacteremic group, bacteremic patients were of lower birth weight (888 ± 231 vs 1127 ± 258 g; P < .01) and gestational age (26.4 ± 2.1 vs 28.9 ± 2.8 weeks; P < .01). In addition, these patients were more severely ill on admission (SNAP 17.3 ± 6.5 vs 12.2 ± 5.8; P < .01). Even after birth weight stratification, the risk of bacteremia by both measures increased with higher SNAP scores. For example, among infants with birth weights greater than 1 kg, 25% of the most severely ill patients (SNAP 20 and higher) experienced at least one bacteremic episode, whereas the rates seen in infants with intermediate (SNAP 10 to 19) and low illness severity (SNAP 0 to 9) were 8.6% and 3.0%, respectively (χ2 for trend = 7.25; P < .01). Multivariate linear regression showed that bacteremia was associated with a prolongation of neonatal intensive care unit stay of 14.0 ± 4.0 days (P < .01) and an increase in hospital charges of $25 090 ± 12 051 (P < .05), even after adjustment for birth weight and admission-day SNAP. Conclusions. Nosocomial coagulase-negative bacteremia is an important complication among very low birth weight infants. Assessment of illness severity with SNAP provides information regarding nosocomial infection risk beyond that available from birth weight alone.

scholarly journals Bacterial Nosocomial Infection: Experience of the Neonatal Intensive Care Unit at the University Hospital of Marrakech

2019 ◽  
Vol 11 (1) ◽  
pp. 17-21
Author(s):  
Asma Helyaich ◽  
Nadia El Idrissi Slitine ◽  
Fatiha Bennaoui ◽  
abdelmounaim Aboussad ◽  
Nabila Soraa ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Nosocomial Infection ◽  
Neonatal Intensive Care Unit ◽  
Nosocomial Infections ◽  
Neonatal Intensive Care ◽  
Severity Of Illness ◽  
University Hospital ◽  
Hygiene Measures

Background and AimNosocomial infections are one of the major causes of morbidity in the Neonatal Intensive Care Unit (NICU). Known risk factors include birth weight, gestational age, severity of illness and its related length of stay, and instrumentation.Objective:The purpose of this article is to determine the occurrence of Nosocomial Infections (NIs), including infection rates, main infection sites, and common microorganisms.Methods:A retrospective study was conducted between June 2015 and December 2016.Results:The incidence of nosocomial infection was 16%. The primary reasons for admission were intauterin growth retardation (52.5%).Klebsiella Pneumoniaewas the most commonly identified agent in the blood cultures and in the hospital unit (43.6%). The mortality rate from nosocomial infection was 52.6%. The proportion of infected newborns with a lower than normal birth weight was predominant (58.13%).Conclusion:Thus, prevention of bacterial infection is crucial in these settings of unique patients. In this view, improving neonatal management is a key step, and this includes promotion of breast-feeding and hygiene measures.

scholarly journals Therapeutic intervention scoring system application in a pediatric intensive care unit

2010 ◽  
Vol 2 (2) ◽  
pp. 96
Author(s):  
Simone Travi Canabarro ◽  
Mariana Parode Bandeira ◽  
Kelly Dayane Stochero Velozo ◽  
Olga Rosária Eidt ◽  
Jefferson Pedro Piva ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
System Application ◽  
Therapeutic Intervention ◽  
Scoring System ◽  
Pediatric Intensive Care ◽  
Therapeutic Intervention Scoring System
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