scholarly journals Performance of PRISM III, PELOD-2, and P-MODS Scores in Two Pediatric Intensive Care Units in China

2021 ◽  
Vol 9 ◽  
Author(s):  
Lidan Zhang ◽  
Yuhui Wu ◽  
Huimin Huang ◽  
Chunyi Liu ◽  
Yucai Cheng ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Roc Curve ◽  
Goodness Of Fit ◽  
Pediatric Patients ◽  
Pediatric Intensive Care ◽  
Goodness Of Fit Test ◽  
Survival Group

Objective: The performances of the pediatric risk of mortality score III (PRISM III), pediatric logistic organ dysfunction score-2 (PELOD-2), and pediatric multiple organ dysfunction score (P-MODS) in Chinese patients are unclear. This study aimed to assess the performances of these scores in predicting mortality in critically ill pediatric patients.Methods: This retrospective observational study was conducted at two tertiary-care PICUs of teaching hospitals in China. A total of 1,253 critically ill pediatric patients admitted to the two Pediatric Intensive Care Units (PICUs) of the First Affiliated Hospital, Sun Yat-Sen University from August 2014 to December 2019 and Shen-Zhen Children's Hospital from January 2019 to December 2019 were analyzed. The indexes of discrimination and calibration were applied to evaluate score performance for the three models (PRISM III, PELOD-2, and P-MODS scores). The receiver operating characteristic (ROC) curve was plotted, and the efficiency of PRISM III, PELOD-2, and P-MODS in predicting death were evaluated by the area under ROC curve (AUC). Hosmer–Lemeshow goodness-of-fit test was used to evaluate the degree of fitting between the mortality predictions of each scoring system and the actual mortality.Results: A total of 1,253 pediatric patients were eventually enrolled in this study (median age, 38 months; overall mortality rate, 8.9%; median length of PICU stay, 8 days). Compared to the survival group, the non-survival group showed significantly higher PRISM III, PELOD-2, and P-MODS scores [PRISM III: 18 (12, 23) vs. 11 (0, 16); PELOD-2, 8 (4, 10) vs. 4 (0, 6); and P-MODS: 5 (4, 9) vs. 3 (0, 4), all P < 0.001]. ROC curve analysis showed that the AUCs of PRISM III, PELOD-2, and P-MODS for predicting the death of critically ill children were 0.858, 0.721, and 0.596, respectively. Furthermore, in the Hosmer–Lemeshow goodness-of-fit test, PRISM III and PELOD-2 showed the better calibration between predicted mortality and observed mortality (PRISM III: χ2 = 5.667, P = 0.368; PELOD-2: χ2 = 9.582, P = 0.276; P-MODS: χ2 = 12.449, P = 0.015).Conclusions: PRISM III and PELOD-2 can discriminate well between survivors and non-survivors. PRISM III and PELOD-2 showed the better calibration between predicted and observed mortality, while P-MODS showed poor calibration.

scholarly journals Comparison of Pediatric Risk of Mortality III, Pediatric Index of Mortality 2, and Pediatric Index of Mortality 3 in Predicting Mortality in a Pediatric Intensive Care Unit

2018 ◽  
Vol 07 (04) ◽  
pp. 201-206 ◽  
Author(s):  
Priyamvada Tyagi ◽  
Mukesh Agrawal ◽  
Milind Tullu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Roc Curve ◽  
Goodness Of Fit ◽  
Pediatric Intensive Care ◽  
Goodness Of Fit Test ◽  
Risk Of Mortality ◽  
Pediatric Index Of Mortality ◽  
Good Calibration

Aims To compare and validate the Pediatric Risk of Mortality (PRISM) III, Pediatric Index of Mortality (PIM) 2, and PIM 3 scores in a tertiary care pediatric intensive care unit (PICU) (Indian setting). Materials and Methods All consecutively admitted patients in the PICU of a public hospital (excluding those with unstable vital signs or cardiopulmonary resuscitation within 2 hours of admission, cardiopulmonary resuscitation before admission, and discharge or death in less than 24 hours after admission) were included. PRISM III, PIM 2, and PIM 3 scores were calculated. Mortality discrimination for the three scores was calculated using the receiver operating characteristic (ROC) curve, and calibration was performed using the Hosmer–Lemeshow goodness-of-fit test. Results A total of 350 patients were included (male:female = 1.3:1) over the study duration of 18 months (median age: 12 months [interquartile range: 4–60 months]). Nearly half were infants (47.4%). Patients with central nervous system disease were the highest (22.8%) followed by cardiovascular system (20.6%). Mortality rate was 39.4% (138 deaths). The area under the ROC curve for the PRISM III score was 0.667, and goodness-of-fit test showed no significant difference between the observed and expected mortalities in any of these categories (p > 0.5), showing good calibration. Areas under the ROC curve for the PIM 2 and PIM 3 scores were 0.728 and 0.726, respectively. For both the scores, the goodness-of-fit test showed good calibration. Conclusions Although all the three scores demonstrate good calibration, the PIM 2 and PIM 3 scores have an advantage regarding the better discrimination ability, ease of data collection, simplicity of computation, and inherent capacity of not being affected by treatment in PICU.

scholarly journals Cefepime Pharmacokinetics in Critically Ill Pediatric Patients Receiving Continuous Renal Replacement Therapy

2019 ◽  
Vol 63 (4) ◽  
Author(s):  
Gideon Stitt ◽  
Jennifer Morris ◽  
Lindsay Schmees ◽  
Joseph Angelo ◽  
Ayse Akcan Arikan
Keyword(s):  
Intensive Care Unit ◽  
Body Weight ◽  
Intensive Care ◽  
Retrospective Study ◽  
Critically Ill ◽  
Pediatric Patients ◽  
Pediatric Intensive Care ◽  
Free Drug ◽  
Therapeutic Drug ◽  
Free Drug Concentration

ABSTRACT This retrospective study included pediatric intensive care unit patients receiving continuous veno-venous hemodiafiltration (CVVHDF) being treated with cefepime. The free drug concentration above one time the MIC (fT>1×MIC) and four times a presumed MIC (fT>4×MIC) of 8 μg/ml were calculated. Four patients received doses ranging from 48 to 64 mg/kg of body weight every 6 to 12 h. Three patients achieved 100% fT>1×MIC, with the fourth patient achieving 98% fT>1×MIC. Therapeutic drug monitoring should be considered for critically ill patients receiving cefepime on CVVHDF.

scholarly journals Piperacillin/Tazobactam and Antibiotic-Associated Acute Kidney Injury in Critically Ill Children

2019 ◽  
Vol 30 (11) ◽  
pp. 2243-2251 ◽  
Author(s):  
Emily L. Joyce ◽  
Sandra L. Kane-Gill ◽  
Priyanka Priyanka ◽  
Dana Y. Fuhrman ◽  
John A. Kellum
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Primary Outcome ◽  
Pediatric Patients ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Lengths Of Stay ◽  
Medication Exposure ◽  
Secondary Outcomes

BackgroundThere continues to be uncertainty about whether piperacillin/tazobactam (TZP) increases the risk of AKI in critically ill pediatric patients. We sought to compare rates of AKI among critically ill children treated with TZP or cefepime, an alternative frequently used in intensive care units, with and without vancomycin.MethodsWe conducted a retrospective cohort study assessing the risk of AKI in pediatric intensive care unit patients after exposure to vancomycin, TZP, and cefepime, alone or in combination, within 48 hours of admission. The primary outcome was development of stage 2 or 3 AKI or an increase in AKI stage from 2 to 3 within the 6 days after the 48-hour exposure window. Secondary outcomes included lengths of stay, need for RRT, and mortality.ResultsOf 5686 patients included, 494 (8.7%) developed stage 2 or 3 AKI. The adjusted odds of developing AKI after medication exposure were 1.56 for TZP (95% confidence interval [95% CI], 1.23 to 1.99), 1.13 for cefepime (95% CI, 0.79 to 1.64), and 0.86 for vancomycin (95% CI, 0.69 to 1.07). The adjusted odds of developing AKI for vancomycin plus TZP versus vancomycin plus cefepime was 1.38 (95% CI, 0.85 to 2.24).ConclusionsObservational data in critically ill children show that TZP use is associated with increased odds of AKI. A weaker, nonsignificant association between vancomycin plus TZP and AKI compared with vancomycin plus cefepime, creates some uncertainty about the nature of the association between TZP and AKI. However, cefepime is an alternative not associated with AKI.

scholarly journals Association of Thrombocytopenia and Mortality in Critically ill Children Admitted to PICU in Tertiary Hospital In Biratnagar

2019 ◽  
Vol 4 (1) ◽  
pp. 649-653 ◽  
Author(s):  
Vijay Kumar Sah ◽  
Arun Giri ◽  
Milan KC ◽  
Niraj Niraula
Keyword(s):  
Intensive Care ◽  
Platelet Count ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Pediatric Intensive Care ◽  
Hemodynamic Instability ◽  
Tertiary Hospital ◽  
Critically Ill Children ◽  
Bleeding Tendency ◽  
Time Of Admission

Introduction: Thrombocytopenia is a clinical condition characterized by decrease in number of platelets below the normal range. It is associated with bleeding tendency, hemodynamic instability, impaired inflammatory process and thus affecting host defence mechanism. There has been only few studies published till date in pediatric intensive care units suggesting thrombocytopenia is associated with increased mortality. Objectives: To determine the prevalence of thrombocytopenia in the critically ill children and its relationship with mortality in Pediatric intensive care unit (PICU) admitted children. Methodology: A prospective observational study was performed over a period of 12 months on 102 critically ill children admitted in PICU who fulfilled the criteria. Two patients left the study due to financial problems and as outcome could not be assessed on them, they were excluded from the study. Platelet count was noted at the time of admission and consecutively for the initial four days at PICU. Thrombocytopenia was defined as platelet count less than 150/nL. Mortality in PICU was recorded as primary outcome. Results: The prevalence of thrombocytopenia during consecutive 4 days was 34% (n=34) and at the time of admission in PICU was 16% (n=16) among 100 children analysed in the study. The mortality in the PICU was 27% (n=27). Mortality among thrombocytopenic children was 61.7% (n=21) as compared to 7.6% (n=5) in non-thrombocytopenic children (p=<0.001). Mortality was 18 times more for those who were thrombocytopenic at the time of admission as compared to those who subsequently developed thrombocytopenia during course of stay in PICU. Conclusion: Thrombocytopenia has significant association with increased mortality. Thrombocytopenic children at the time of admission have more likelihood of mortality than nonthrombocytopenic children in intensive care units.

scholarly journals 3 In-Hospital Child Mortality after Consolidation of Two Pediatric Intensive Care Units

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e1-e2
Author(s):  
Sehar Parvez ◽  
Juliet Soper
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Cause Of Death ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Canadian Province ◽  
Pediatric Intensive Care Units ◽  
Hospital Deaths ◽  
Population Rate

Abstract Background While high-volume specialized Pediatric Intensive Care Units (PICUs) increase the survival of critically ill children, the benefits of consolidating PICUs to a single site may be outweighed by the need to transport critically ill children when the area serviced has a low population density and vast geography. Objectives This study seeks to describe the impact of PICU consolidation on mortality of children from the southern part of a Canadian province, after presentation to nearest hospital, following consolidation of PICUs to a single more centrally located PICU. Design/Methods We conducted a retrospective chart review of children with a primary residence in the southern part of the province, who died between January 2008 and December 2017 after presentation to the nearest hospital. Children who died prior to presentation to hospital or did not have return of spontaneous circulation at any time after presentation were excluded from analysis. Child demographics, year of death, cause of death, and Pediatric Risk of Mortality III (PRISM III) score, and duration and type of treatments provided were abstracted from health records. Population census data was obtained from the 2016 Canada Census. Deaths were grouped for analysis according to the child’s place of residence within three specific administrative areas. Nonparametric Mann Whitney U-test was used for descriptive analysis. Results Eighty-six (86) children from the southern part of the province died following presentation to the nearest hospital during the 10-year study period. The observed population rate of in-hospital deaths was 6.8 per 100,000 children per year before consolidation and 8.5 per 100,000 children per year after consolidation of PICU services. Variation in the population rate of in-hospital deaths before and after consolidation of PICUs was observed between administrative areas (p=0.016). The data did not appear to show an association with urban or non-urban areas. Children who died after consolidation were more likely to receive pain relief (p=0.013), and palliative care consultation (p=0.005) than those who died prior to consolidation. No change in acuity at presentation to hospital or cause of death was observed following PICU consolidation (p=0.3). Conclusion This study did not find evidence of a change in the rate of in-hospital child deaths per 100,000 children following consolidation of PICU services in a Canadian province.

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