scholarly journals Performance of PRISM score III in predicting the outcome of patients admitted in tertiary care pediatric intensive care unit (P.I.C.U.): A pilot study

2017 ◽  
Vol 1 (1) ◽  
pp. 28
Author(s):  
Laraib Malik
Keyword(s):  
Pilot Study ◽  
Tertiary Care Hospital ◽  
White Cell Count ◽  
Tertiary Care ◽  
Standards Of Care ◽  
Care Hospital ◽  
Pupillary Reflex ◽  
Prism Score ◽  
Poor Outcome ◽  
Arterial Blood

Introduction: P.I.C.U is a unit that provides care to the critically ill patients with purpose of reducing the rate of mortality and morbidity. Various scoring systems are used to assess and compare the standards of care of different P.I.C.U.s. Among them, PRISM III scoring has shown promising results, especially in developing countries. In Pakistan, these studies are fewer in numbers with conflicting results in different hospital settings (private and public sector). Since our hospital is also a tertiary care hospital, we planned a pilot study to evaluate PRISM III score in our P.I.C.U.    Objective: To evaluate the performance of PRISM III score in predicting the    outcome of patients admitted in P.I.C.U of tertiary care hospital of Karachi. Method: PRISM III is Pediatric Risk of Mortality Scoring system consisting of clinical    assessment (Glasgow Coma Scale, pupillary reflex, temperature, heart rate, systolic blood pressure) and lab parameters (arterial blood gas, urea, nitrogen, creatnine, blood sugar, potassium, white cell count, platelets, PT/APTT). It is a cross-sectional study and data was collected from admitted patients in P.I.C.U, Unit II of Abbasi Shaheed Hospital during 1st October to 31st December 2016. PRISM score is being calculated from all the patients within 24 hours of admission. Result: Total of 70  patients of which 51(72%) survived and 19(27%) expired. 49 were males and 21   females. Age range of non-survivors was 2 to 18 months. Duration of PI.C.U stay was 72 hours for survivors. Patients who were referred, had malnutrition, depressed  mental status, deranged renal functions and required mechanical ventilation during first hour of admission had poor outcome. Out of 19 non-survivors, PRISM III   predicted mortality in 15 patients (78.9%). Conclusion: High total PRISM III score was significantly associated with poor outcome i.e. death in this pilot study. Thus PRISM III score was found to be a valid predictor of outcome in our P.I.C.U. There is no conflict of interest keywords: P.I.C.U, Mortality, PRISM III score, Outcome.

scholarly journals Prediction of the risk of mortality in paediatric intensive care unit using PRISM III score

2019 ◽  
Vol 6 (3) ◽  
pp. 1186
Author(s):  
Aashay Abhay Shah ◽  
Dileep Goyal ◽  
Devendra Sareen
Keyword(s):  
Intensive Care Unit ◽  
Paediatric Intensive Care Unit ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Stability Index ◽  
Hospitalized Children ◽  
Care Hospital ◽  
Prism Score ◽  
Risk Of Mortality ◽  
Expected Mortality

Background: is the Pediatric risk of mortality (PRISM) score which has been devised by Pollock et al, to predict the mortality in hospitalized children. PRISM score is a revised form of physiologic stability index of mortality score.Methods: A observational prospective study was conducted at tertiary care hospital, Udaipur Rajasthan over period of March 2017 to September 2018. Total 207 patient were enrolled in study as per inclusion and exclusion criteria.Results: Total 29.92% had PRISM III score of 0 to 5, 25.45% had score of 6-10, 16.53% had score of 11-15, 13.12% had score of 16-20, 7.61% between 21 to 25, 4.72% between 26-30 and 2.62% had score of greater than 30. There was no mortality when the PRISM score of the child was between 0 to 5. The percentage of deaths increased progressively with increasing PRISM score.Conclusions: There was no significance difference in predicted from PRISM score and the actual death. The expected mortality was comparable to actual death, except in children who required mechanical ventilation and vasopressor drugs.

scholarly journals A study of Acute Liver Failure in adults in a tertiary care hospital

2019 ◽  
Vol 5 (6) ◽  
pp. 204-207
Author(s):  
Dr. Mohini Singh ◽  
◽  
Dr. Srilakshmi Sathiyaseelan ◽  
Devarasetty Shashank ◽  
Dr. S.R. Ramakrishnan ◽  
...  
Keyword(s):  
Liver Function ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Viral Hepatitis ◽  
Tertiary Care Hospital ◽  
Early Recognition ◽  
Tertiary Care ◽  
Care Hospital ◽  
Arterial Blood ◽  
Function Test

Acute liver failure (ALF) is a condition with rapid deterioration of liver function resulting in hepatic encephalopathy and/or coagulopathy in patients with previously normal liver. Acute liver failure (ALF) is an uncommon condition associated with high morbidity and mortality. The prognosis is poor for untreated cases of Acute liver failure, so early recognition and management of patients with acute liver failure is crucial. A cause for acute liver failure can be identified in 60 to 80 percent of patients. Identifying the underlying cause of the liver failure is important because it influences the approach to management and provides prognostic information. Aims and Objectives: The aim of our study is to identify the clinical features, etiology and outcome of acute liver failure in a tertiary care hospital. Materials and Methods: This study is an observational study where patients with Acute Liver Failure admitted in ICU in our institution after meeting the diagnostic criteria for Acute liver failure were included in the study. Details of history, relevant symptoms and baseline investigations included, complete blood count, blood glucose, renal function test, serum electrolytes, liver function test (LFT), prothrombin time, international normalized ratio (INR), lactate dehydrogenase (LDH), creatine kinase (CK)], arterial blood gas analysis, arterial lactate, arterial ammonia, amylase and lipase level and pregnancy test (if female) and ultrasonography (USG) abdomen were recorded, MRI brain and other investigations relevant to the admission diagnosis, co morbidities and aetiology if needed were recorded. All the patients received standard supportive treatment for ALF. Results: In this study of 57 patients, majority of the patients were from the age group 41 to 50 years (17 patients) and 31 to 40 years (13 patients). 36 patients were male and 21 patients were females. Jaundice and encephalopathy was observed in all 57 (100%) patients, 24 (42%) patients had INR >2.5, 27 (47%) patients had serum creatinine >1.2 mg/dl and 18 (31.5%) patients had serum ammonia levels >100 micromol/L. The lowest value for serum aminotranferase was observed in infections (other than viral hepatitis) and maximum value was observed in drugs leading to ALF.In 20 (35%) patients viral hepatitis was the cause for ALD, followed by drugs and toxins which was the cause of ALD in 18 (31.5%) patients. Infections other viral hepatitis as the aetiology for ALF was observed in 16 (28%) of patients. Ischemic hepatitis was observed in 1 and Wilson’s disease was noted in 2 patients. Total 6 (10.5%) patients out of 57 patients had died, 4 patients with hepatitis B infection, 1 patient with paracetamol over dosage and 1 patient with dengue fever had died. Conclusion: Viral hepatitis and drugs are the commonest cause for acute liver failure. The aetiology of ALF varies significantly worldwide. Determining the etiology of acute liver failure requires a combination of detailed history taking and investigations. A broad evaluation is required to identify a cause of the acute liver failure, as the prognosis is poor in untreated cases of acute liver failure, so early recognition and management of patients with acute liver failure is crucial.

scholarly journals A PILOT STUDY ON BACTERIAL PROFILE OF NEONATAL SEPSIS IN A TERTIARY CARE HOSPITAL SERVING RURAL POPULATION

2014 ◽  
Vol 3 (23) ◽  
pp. 6378-6381
Author(s):  
Nikhil Kumar Tudu ◽  
Rupali Dey ◽  
Indrani Bhattacharya ◽  
Soumitra Roy ◽  
Jayanta Bikash Dey
Keyword(s):  
Pilot Study ◽  
Neonatal Sepsis ◽  
Rural Population ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital

Clinicomycological study of Candida isolates in a tertiary care hospital: A pilot study

2021 ◽  
Vol 35 (2) ◽  
pp. 58
Author(s):  
AnupmaJyoti Kindo ◽  
Shibani Mishra ◽  
Anitha Subramanian
Keyword(s):  
Pilot Study ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital

scholarly journals A Descriptive Study on Sepsis: Causes, Outcomes, and Adherence to Guidelines on Patients with Sepsis at a Tertiary Care Hospital in Sri Lanka

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Anne Thushara Matthias ◽  
J. Indrakumar ◽  
Tharushi Ranasinghe ◽  
Shalini Wijekoon ◽  
Charuni Yashodara
Keyword(s):  
Sri Lanka ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Bundle ◽  
Common Source ◽  
Care Hospital ◽  
Poor Countries ◽  
Arterial Blood ◽  
Resource Poor ◽  
Sepsis Care

The global incidence of sepsis is increasing, and mortality remains high. The mortality is even higher in resource-poor countries where facilities and equipment are limited. The Surviving Sepsis Campaign (SSC) recommends an updated hour-1 bundle based on the evidence from the International Guidelines for Management of Sepsis and Septic Shock 2018. To reduce mortality from sepsis, compliance with the “bundle” is essential. Data from developing countries like Sri Lanka on the management of sepsis according to the SSC guidelines are not available. Hence, this study looks at the patient characteristics and management of septic patients at a tertiary care hospital in Sri Lanka. Patients admitted to the University Medical Unit of Colombo South Teaching Hospital from January to August 2019 fulfilling the inclusion criteria were included. The hour-1 sepsis bundle adherence, demographic data, and management were recorded. There were 387 patients: 163 males and 224 females. The age range was 15-95 with a mean age of 63. 83.7% were direct admissions while 16.3% were transfers from a peripheral hospital. The most common source of infection was urine (82 (21.2%)) followed by blood stream (105 (27.1%)) and skin and soft tissue (114 (29.5%)). One-hour SSC bundle compliance is as follows: administration of intravenous fluids: 42 (10.9%), blood cultures before antibiotics: 225 (58.1%), first dose antibiotic: 15 (3.9%), and arterial blood gas: 60 (15.5%). Staffing capacity did not make a difference to adherence to the bundle. The study mortality rate was 37 (9.6%). Binary logistic regression indicates that quick sequential organ failure assessment (qSOFA) score is a significant predictor of mortality (chi‐square=35.08, df=3, and p=0.001 (<0.05)) with an odds ratio (OR) of 7.529 (95% CI 3.597-14.323). The other predictors, age, sex, adherence to sepsis care bundle, and comorbidities, were not significant. In conclusion, mortality of sepsis is high and adherence to sepsis care bundle is poor in Sri Lanka even at a tertiary care hospital. Education and training of staff are needed to boost adherence. This will in turn improve quality of care and outcomes of septic patients in resource-poor countries.

scholarly journals The Evolving Pattern and Outcome of Stroke at Moderate Altitude

2018 ◽  
Vol 09 (01) ◽  
pp. 068-072
Author(s):  
Deepika Dhiman ◽  
Sanjay K. Mahajan ◽  
Sudhir Sharma ◽  
Rajiv Raina
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Coronary Artery Disease ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Moderate Altitude ◽  
Care Hospital ◽  
Altered Sensorium ◽  
Poor Outcome ◽  
Artery Disease

ABSTRACT Background: The people residing in hills of this Sub-Himalayan region traditionally have a distinct lifestyle involving high level of physical activity. However, increased urbanization in the last two decades has led to changes in lifestyle of people. The present study was an endeavor to document changes in the pattern of stroke in people residing at moderate altitude. Aim: This study was aimed to study the evolving trends in clinical profile, risk factors, and outcome at 3 months in hospitalized patients of stroke in a Tertiary Care Hospital situated at moderate altitude. Setting and Design: This prospective, observational study was carried out in a Tertiary Care Hospital, situated at 2000 m mean sea level, from July 2014 to June 2015 in Sub-Himalayan region of India. Methods: The clinical features and risk factors profile of 235 patients of stroke consecutively admitted in hospital were analyzed, and findings were expressed in percentage. The profile was compared with a study conducted at this institute 15 years back. The outcome of patients at 3 months in terms of modified Rankin Scale >3 (mRS) and Barthel Index <60 (BI) was also studied. Results: The occurrence of stroke as a cause of hospitalization was decreasing. Ischemic stroke was noted in 74%, and 26% had hemorrhagic stroke (HS). There was male predominance (58%), but affliction of females with stroke increased from 34% to 42%. The altered sensorium (P = 0.00) and neurological weakness (P = 0.024) were significantly associated with poor outcome in stroke. The occurrence of hypertension, diabetes mellitus, and coronary artery disease increased but smoking decreased among indoor patients of stroke in the last 15 years. Poor outcome of 203 patients at 3 months follow-up in terms of mRS >3 was 79 (IS-47, HS-32) but in term of BI, 63 (IS-32, HS-31) had poor outcome. Overall HS had poorer outcome. Age >70 years, female sex, altered sensorium, hypertension, and diabetes mellitus, were observed as poor prognostic factors, but the association was significant with advanced age, headache, and altered sensorium. Conclusion: The occurrence of stroke decreased among hospitalized patients. Hypertension, diabetes mellitus, and coronary artery disease increased but smoking decreased among patients of stroke.

Profile of Patients Hospitalized through the Emergency Room to the Medicine Ward and their Short-term Outcome at a Tertiary Care Hospital in Delhi

2015 ◽  
Vol 30 (6) ◽  
pp. 593-598 ◽  
Author(s):  
Rahul Choudhary ◽  
Ashish Goel ◽  
Sonal Pruthi ◽  
Sarathi Kalra ◽  
Sunil Agarwal ◽  
...  
Keyword(s):  
Emergency Room ◽  
Tertiary Care Hospital ◽  
Mmse Score ◽  
Tertiary Care ◽  
Care Hospital ◽  
Short Term ◽  
Term Outcome ◽  
Arterial Blood ◽  
Short Term Outcome ◽  
Gcs Score

AbstractIntroductionWith an increasing number of sicker patients, limited hospital beds, and an emphasis on day care, the profile of patients hospitalized to medicine wards has undergone a radical re-definition. The increasing share of patients hospitalized through the emergency department for acute care to medicine wards has left little space for hospitalization through the outpatient department (OPD). There are some global data available on the profile of patients presenting to the emergency rooms (ERs) and their subsequent outcome. Data from developing countries, especially India, in this regard are lacking.MethodsThis cross-sectional study included all patients hospitalized to the medicine ward through the medical emergency services, provided by the Department of Medicine, each Wednesday and every sixth Sunday for the entire year (a total of 62 days), from November 2010 through October 2011, and followed their outcome up to seven days after hospitalization.ResultsOf the 3,618 cases presenting to medicine emergency on these days, 1,547 (42.3%) were advised admission. Nine hundred sixty-seven reported to the medicine wards. One hundred eleven (7.73%) expired within 24 hours; others absconded, were lost in transit, did not consent to participation, or were discharged. During the next seven days, 452 (46.7%) recovered sufficiently and were discharged to go home. Two hundred thirty (23.8%) left the hospital without informing the medical staff. Fourteen (1.4%) patients were transferred to other departments. One hundred thirty-seven (8.8%) patients died during the next six days of hospitalization. After Multivariate Logistic Regression analysis, abnormal Glasgow Coma Scale (GCS) score, high systolic blood pressure (BP), age, increased total leucocyte count, increased globulin, low bicarbonate in arterial blood, low Mini Mental Status Examination (MMSE) score, and a raised urea >40 mg/dL were found to be associated significantly with mortality.ConclusionOf the 1,547 patients who needed urgent hospitalization, 248 (16%) died within the first week, one-half of them within the first 24 hours. An advanced age, abnormal GCS score, low MMSE score, increased systolic BP, leukocytosis, acidosis, and uremia were found to be associated with a fatal outcome. Therefore, nearly one-half of the patients who would have a fatal short-term outcome were likely to do so within the first 24 hours, making the first day of presentation “the golden day” period.ChoudharyR, GoelA, PruthiS, KalraS, AgarwalS, KalraOP. Profile of patients hospitalized through the emergency room to the medicine ward and their short-term outcome at a tertiary care hospital in Delhi. Prehosp Disaster Med. 2015;30(6):593–598.

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