scholarly journals Comparison of PICU Cost and Severity-Adjusted Cost Between Patients With SIRS-Defined Sepsis and Those With Age-Adapted SOFA-Defined Sepsis

2021 ◽  
Vol 9 ◽  
Author(s):  
Xuepeng Zhang ◽  
Kaibo Sun ◽  
Guoyan Lu ◽  
Liwei Feng ◽  
Siyuan Chen ◽  
...  
Keyword(s):  
Pediatric Intensive Care ◽  
Clinical Trial Registration ◽  
Prism Score ◽  
Adjusted Cost ◽  
Risk Of Mortality ◽  
Significant Difference ◽  
International Pediatric ◽  
Risk Patients ◽  
Study Population ◽  
Pediatric Sepsis

Background: The 2005 International Pediatric Sepsis Consensus definition is considered to lack specificity and may lead to the admission of low-risk patients to the pediatric intensive care unit (PICU). The aim of this study was to compare the PICU cost and the severity-adjusted cost between patients with sepsis defined by the 2005 International Pediatric Sepsis Consensus and those diagnosed using the age-adapted Sepsis-3 criteria.Methods: Septic children identified by the 2005 Consensus were screened for enrollment. The enrolled children were stratified into two subgroups using the age-adapted Sepsis 3.0 definition. A comparison was made between the subgroups of sepsis 3.0-defined children and non-sepsis 3.0-defined septic children. The Severity Adjusted ICU Cost (SAIC) was used to evaluate the case-mixed severity-adjusted costs of the study population. Coefficients in linear regression analyses in subgroups were calculated for presenting variation of PICU costs for every unit change of PRISM score.Results: A total of 397 children were enrolled. The PICU length of stay was longer in the sepsis 3.0 group than in the non-sepsis 3.0 group [median (IQR), 9.0 (5.0, 15.0) vs. 6.0 (3.0, 9.0); P < 0.001]. Pediatric risk of mortality (PRISM) scores and mortality were significantly higher in sepsis 3.0-defined septic patients. The total costs and daily costs in the PICU were both significantly lower in the non-sepsis 3.0 group (P < 0.001). The severity-adjusted ICU cost in the non-sepsis 3.0 group was lower than that in the sepsis 3.0 group [median (IQR), 7,125 (3,588, 11,134) vs. 9,364 (5,680, 15,876); P = 0.001]. There was no significant difference among the regression coefficients.Conclusions: The 2005 International Pediatric Sepsis Consensus definition does not lead to more PICU costs after considering illness severity.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03598127.

scholarly journals Dialyzable Leukocyte Extract (Transferon™) Administration in Sepsis: Experience from a Single Referral Pediatric Intensive Care Unit

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Maria Isabel Castrejón Vázquez ◽  
Aldo Arturo Reséndiz-Albor ◽  
Mario A. Ynga-Durand ◽  
Ivonne Maciel Arciniega Martínez ◽  
Vanessa Ivonne Orellana-Villazon ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Laboratory Data ◽  
Pediatric Intensive Care ◽  
Control Group ◽  
Immunomodulatory Agents ◽  
Reactive Protein ◽  
Significant Difference ◽  
Pediatric Sepsis

Immunomodulatory agents have been proposed as therapeutic candidates to improve outcomes in sepsis. Transferon™, a dialyzable leukocyte extract (DLE), has been supported in Mexico as an immunomodulatory adjuvant in anti-infectious therapy. Here we present a retrospective study describing the experience of a referral pediatric intensive care unit (PICU) with Transferon™ in sepsis. We studied clinical and laboratory data from 123 patients with sepsis (15 in the DLE group and 108 in the control group) that were admitted to PICU during the period between January 2010 and December 2016. Transferon™ DLE use was associated with lower C reactive protein (CRP), increase in total lymphocyte counts (TLC), and decrease in total neutrophil count (TNC) 72 hours after Transferon™ DLE administration. The control group did not present any significant difference in CRP values and had lower TLC after 72 hours of admission. There was no difference in PICU length of stay between control and Transferon™ DLE group. Transferon™ DLE administration was associated with a higher survival rate at the end of PICU stay. This study shows a possible immunomodulatory effect of Transferon™ on pediatric sepsis patients.

Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease – the perspective of critical care

2008 ◽  
Vol 18 (S2) ◽  
pp. 130-136 ◽  
Author(s):  
Joan M. LaRovere ◽  
Howard E. Jeffries ◽  
Ramesh C. Sachdeva ◽  
Thomas B. Rice ◽  
Randall C. Wetzel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Scoring System ◽  
Quantitative Measurement ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Paediatric Intensive Care ◽  
Prism Score ◽  
Risk Of Mortality ◽  
Predicted Risk

AbstractThe development of databases to track the outcomes of children with cardiovascular disease has been ongoing for much of the last two decades, paralleled by the rise of databases in the intensive care unit. While the breadth of data available in national, regional and local databases has grown exponentially, the ability to identify meaningful measurements of outcomes for patients with cardiovascular disease is still in its early stages.In the United States of America, the Virtual Pediatric Intensive Care Unit Performance System (VPS) is a clinically based database system for the paediatric intensive care unit that provides standardized high quality, comparative data to its participants [https://portal.myvps.org/]. All participants collect information on multiple parameters: (1) patients and their stay in the hospital, (2) diagnoses, (3) interventions, (4) discharge, (5) various measures of outcome, (6) organ donation, and (7) paediatric severity of illness scores. Because of the standards of quality within the database, through customizable interfaces, the database can also be used for several applications: (1) administrative purposes, such as assessing the utilization of resources and strategic planning, (2) multi-institutional research studies, and (3) additional internal projects of quality improvement or research.In the United Kingdom, The Paediatric Intensive Care Audit Network is a database established in 2002 to record details of the treatment of all critically ill children in paediatric intensive care units of the National Health Service in England, Wales and Scotland. The Paediatric Intensive Care Audit Network was designed to develop and maintain a secure and confidential high quality clinical database of pediatric intensive care activity in order to meet the following objectives: (1) identify best clinical practice, (2) monitor supply and demand, (3) monitor and review outcomes of treatment episodes, (4) facilitate strategic healthcare planning, (5) quantify resource requirements, and (6) study the epidemiology of critical illness in children.Two distinct physiologic risk adjustment methodologies are the Pediatric Risk of Mortality Scoring System (PRISM), and the Paediatric Index of Mortality Scoring System 2 (PIM 2). Both Pediatric Risk of Mortality (PRISM 2) and Pediatric Risk of Mortality (PRISM 3) are comprised of clinical variables that include physiological and laboratory measurements that are weighted on a logistic scale. The raw Pediatric Risk of Mortality (PRISM) score provides quantitative measures of severity of illness. The Pediatric Risk of Mortality (PRISM) score when used in a logistic regression model provides a probability of the predicted risk of mortality. This predicted risk of mortality can then be used along with the rates of observed mortality to provide a quantitative measurement of the Standardized Mortality Ratio (SMR). Similar to the Pediatric Risk of Mortality (PRISM) scoring system, the Paediatric Index of Mortality (PIM) score is comprised of physiological and laboratory values and provides a quantitative measurement to estimate the probability of death using a logistic regression model.The primary use of national and international databases of patients with congenital cardiac disease should be to improve the quality of care for these patients. The utilization of common nomenclature and datasets by the various regional subspecialty databases will facilitate the eventual linking of these databases and the creation of a comprehensive database that spans conventional geographic and subspecialty boundaries.

scholarly journals Circulating Vitronectin Predicts Liver Injury and Mortality in Children With Sepsis: A Prospective Observational Study

2020 ◽  
Vol 26 ◽  
pp. 107602962093520
Author(s):  
Chunxia Wang ◽  
Yun Cui ◽  
Huijie Miao ◽  
Ting Sun ◽  
Ye Lu ◽  
...  
Keyword(s):  
Liver Injury ◽  
Clinical Utility ◽  
Prospective Observational Study ◽  
Operating Characteristic ◽  
Pediatric Patients ◽  
Characteristic Curve ◽  
Pediatric Intensive Care ◽  
Decision Curve Analysis ◽  
Risk Of Mortality ◽  
Pediatric Sepsis

Vitronectin (VTN) is a key regulator of coagulation, but clinical relevance of serum VTN in pediatric sepsis remains poorly defined. The aim of this study was to access the value of serum VTN level on pediatric intensive care unit (PICU) admission in children with sepsis. Pediatric patients with sepsis were enrolled from January 2018 to December 2018. The serum VTN levels were determined on PICU admission, and the association of serum VTN level with PICU mortality and organ dysfunction was assessed. Serum VTN levels were significantly lower in nonsurvivors compared with survivors, in patients with septic shock compared with patients with sepsis, or in patients with sepsis-associated acute liver injury (ALI) compared with patients without ALI. Serum VTN level was associated with PICU mortality (odds ratio [OR]: 0.958, 95% CI: 0.927-0.996; P = .010) or ALI (OR: 0.956, 95% CI: 0.915-0.999; P = .046), but not shock (OR: 0.996, 95% CI: 0.977-1.016; P =.716). The area under receiver operating characteristic curve for VTN in predicting the occurrence of ALI during PICU stay and PICU mortality were 0.760 (95% CI: 0.627- 0.893) and 0.737 (95% CI: 0.544-0.931), respectively. Moreover, VTN plus pediatric risk of mortality (PRISM) III had a better clinical utility according to decision curve analysis compared with VTN or PRISM III alone. These findings suggest that serum VTN level is associated with sepsis-associated ALI and PICU mortality, and VTN plus PRISM III is a powerful predictor of PICU mortality in pediatric patients with sepsis, which have a better clinical benefit compared with VTN or PRISM III alone.

Abstract 6: Treatment Effect of Clopidogrel Plus Aspirin Within 12 Hours of Acute Minor Stroke or TIA

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Zixiao Li ◽  
Yilong Wang ◽  
Xingquan Zhao ◽  
Liping Liu ◽  
Ying Xian ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Minor Stroke ◽  
Unique Identifier ◽  
Clinical Trial Registration ◽  
Cerebrovascular Events ◽  
Significant Difference ◽  
Hemorrhagic Events ◽  
Hemorrhagic Risk ◽  
Risk Patients

Background and Purpose: The aim of this study was to analyze the benefits and safety associated with the combination therapy of clopidogrel and aspirin within 12 hours. Methods: This was a subanalysis of the CHANCE (Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events) trial, mainly limited to the prespecified group of patients presenting within 12 hours to either the combination of clopidogrel plus aspirin or aspirin alone. The primary outcome was ischemic stroke during 90-day follow-up. Results: Among 2573 patients randomized within 12 hours, 282 (10.96%) patients had ischemic stroke events. Among them, 113 (40.07%) occurred within 24 hours of symptom onset. Randomization within 12 hours was an independent predictor of ischemic stroke events (P=0.02). One hundred and fifty-eight (12.34%) of 1280 patients on aspirin experienced ischemic stroke compared to 124 (9.59%) of 1293 patients on clopidogrel-aspirin (P=0.02). The dual antiplatelet was more effective than aspirin alone in reducing the risk of recurrent ischemic stroke (6.57% vs. 8.91%, P=0.03), but not progressive ischemic stroke (3.02% vs. 3.43%, P=0.28) (Table 1). There was no significant difference in hemorrhagic events (P=0.39). Conclusions: Among patients treated within 12 hours, the combination of clopidogrel and aspirin was more effective than aspirin alone in reducing the risk of recurrent ischemic stroke during the 90-day follow-up and did not increase the hemorrhagic risk. The higher ischemic stroke rate in the initial hours after stroke supports early more aggressive antiplatelet therapy. Clinical Trial Registration-URL: http//www.clinicaltrials.gov . Unique identifier: NCT00979589.

scholarly journals Assessing the Attitude of Tampa Bay Youth toward HIV Self-Testing Kits

2021 ◽  
Vol 6 (3) ◽  
pp. 111
Author(s):  
Sherry Zhang ◽  
Isabella Lopez ◽  
Bernard Washington ◽  
Brittney Gaudet ◽  
Carina A. Rodriguez ◽  
...  
Keyword(s):  
Tampa Bay ◽  
Hiv Status ◽  
Health Clinics ◽  
Home Testing ◽  
Self Testing ◽  
Significant Difference ◽  
The Us ◽  
Study Population ◽  
Location Study ◽  
Sexual Health Clinics

In adults, data support the utility and acceptance of home HIV testing; however, in youth, particularly in the US, this has not been well studied. In this exploratory study, we surveyed Tampa Bay youth aged 16−27 and attending sexual health clinics between 1 June and 31 June 2018 (n = 133) regarding attitudes and perceptions towards HIV self-testing. While most indicated the clinic over home when asked for preferred testing location, study population and subgroup analysis demonstrated a positive response (agree) to Likert-scale questions regarding the use of home HIV self-testing kits and negative responses (strongly disagree) to “would not use self-testing kit”. There was a significant difference between genders in testing location preference (p = 0.031) for those respondents that specified gender (n = 123), with males more likely to prefer home testing than females. This study suggests an openness of youth towards HIV home testing that could help to expand the number of youth aware of their HIV status.

scholarly journals Preliminary analysis of prostate positional displacement using hydrogel spacer during the course of proton therapy for prostate cancer

2020 ◽  
Author(s):  
Hiroki Sato ◽  
Takahiro Kato ◽  
Tomoaki Motoyanagi ◽  
Kimihiro Takemasa ◽  
Yuki Narita ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Proton Therapy ◽  
Rectal Dose ◽  
Prostate Motion ◽  
Significant Difference ◽  
Risk Prostate Cancer ◽  
Bony Anatomy ◽  
Study Population ◽  
Planning Ct ◽  
Anterior Posterior

Abstract In recent years, a novel technique has been employed to maintain a distance between the prostate and the rectum by transperineally injecting a hydrogel spacer (HS). However, the effect of HS on the prostate positional displacement is poorly understood, despite its stability with HS in place. In this study, we investigated the effect of HS insertion on the interfraction prostate motion during the course of proton therapy (PT) for Japanese prostate cancer patients. The study population consisted of 22 cases of intermediate-risk prostate cancer with 11 cases with HS insertion and 11 cases without HS insertion. The irradiation position and preparation were similar for both groups. To test for reproducibility, regular confirmation computed tomography (RCCT) was done four times during the treatment period, and five times overall [including treatment planning CT (TPCT)] in each patient. Considering the prostate position of the TPCT as the reference, the change in the center of gravity of the prostate relative to the bony anatomy in the RCCTs of each patient was determined in the left–right (LR), superior–inferior (SI) and anterior–posterior (AP) directions. As a result, no significant difference was observed across the groups in the LR and SI directions. Conversely, a significant difference was observed in the AP direction (P < 0.05). The proportion of the 3D vector length ≤5 mm was 95% in the inserted group, but 55% in the non-inserted group. Therefore, HS is not only effective in reducing rectal dose, but may also contribute to the positional reproducibility of the prostate.

scholarly journals Diagnostic Value of C-Reactive Protein in Discrimination between Uncomplicated and Complicated Parapneumonic Effusion

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 829
Author(s):  
Yana Kogan ◽  
Edmond Sabo ◽  
Majed Odeh
Keyword(s):  
Area Under The Curve ◽  
Diagnostic Value ◽  
Parapneumonic Effusion ◽  
C Reactive Protein ◽  
Diagnostic Efficacy ◽  
Reactive Protein ◽  
Significant Difference ◽  
Study Population ◽  
Complicated Parapneumonic Effusion

Objectives: The role of serum C-reactive protein (CRPs) and pleural fluid CRP (CRPpf) in discriminating uncomplicated parapneumonic effusion (UCPPE) from complicated parapneumonic effusion (CPPE) is yet to be validated since most of the previous studies were on small cohorts and with variable results. The role of CRPs and CRPpf gradient (CRPg) and of their ratio (CRPr) in this discrimination has not been previously reported. The study aims to assess the diagnostic efficacy of CRPs, CRPpf, CRPr, and CRPg in discriminating UCPPE from CPPE in a relatively large cohort. Methods: The study population included 146 patients with PPE, 86 with UCPPE and 60 with CPPE. Levels of CRPs and CRPpf were measured, and the CRPg and CRPr were calculated. The values are presented as mean ± SD. Results: Mean levels of CRPs, CRPpf, CRPg, and CRPr of the UCPPE group were 145.3 ± 67.6 mg/L, 58.5 ± 38.5 mg/L, 86.8 ± 37.3 mg/L, and 0.39 ± 0.11, respectively, and for the CPPE group were 302.2 ± 75.6 mg/L, 112 ± 65 mg/L, 188.3 ± 62.3 mg/L, and 0.36 ± 0.19, respectively. Levels of CRPs, CRPpf, and CRPg were significantly higher in the CPPE than in the UCPPE group (p < 0.0001). No significant difference was found between the two groups for levels of CRPr (p = 0.26). The best cut-off value calculated by the receiver operating characteristic (ROC) analysis for discriminating UCPPE from CPPE was for CRPs, 211.5 mg/L with area under the curve (AUC) = 94% and p < 0.0001, for CRPpf, 90.5 mg/L with AUC = 76.3% and p < 0.0001, and for CRPg, 142 mg/L with AUC = 91% and p < 0.0001. Conclusions: CRPs, CRPpf, and CRPg are strong markers for discrimination between UCPPE and CPPE, while CRPr has no role in this discrimination.

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