Related Experiment Video
Updated: Aug 3, 2026
Murine Model of Intestinal Ischemia-reperfusion Injury
Published on: May 11, 2016
Triage score for severity of illness
1Departments of Pediatrics and Neonatology, St. Stephen's Hospital, Tis Hazari, Delhi 110 054, India. nsk9_2000@yahoo.com
Insights
A new scoring system using clinical variables can identify critically ill children. A score of 2 or more abnormal variables indicates serious illness, guiding urgent care for better survival outcomes in pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Clinical scoring systems
- Systemic inflammatory response syndrome (SIRS)
Background:
- Developing effective triage tools is crucial for managing pediatric emergencies.
- Systemic inflammatory response syndrome (SIRS) is a critical condition requiring prompt assessment.
- Existing scoring systems may not fully capture the severity of illness in pediatric patients.
Purpose of the Study:
- To develop and validate a novel triage scoring system for pediatric illness severity.
- To correlate clinical variables with patient outcomes, specifically mortality.
- To identify a reliable cut-off score for identifying high-risk pediatric patients.
Main Methods:
- Prospective study involving 1099 pediatric patients in a tertiary-care hospital.
- Assessed clinical variables including respiratory rate, heart rate, capillary refill time, SpO2, blood pressure, temperature, and sensorium (AVPU scale).
- Utilized Systemic Inflammatory Response Syndrome (SIRS) and Advanced Pediatric Life Support (APLS) criteria; analyzed data using logistic regression and ROC curve analysis.
Main Results:
- Mortality increased significantly with a higher number of abnormal clinical variables (P < 0.01).
- A score of 2 or more abnormal variables was associated with significantly higher mortality.
- The regression-based score demonstrated strong predictive ability (Area under ROC curve = 0.887), with optimal discrimination at a score of 2.5 (sensitivity 84.1%, specificity 82.2%).
Conclusions:
- A triage score of 2 or more abnormal clinical variables identifies children at high risk of death.
- A cut-off score of 2.5 is recommended for selecting pediatric patients requiring admission and close monitoring.
- This scoring system can aid in efficient triage and resource allocation for critically ill children.
Objective:
To evolve a triage scoring system for severity of illness based on clinical variables related to systemic inflammatory response syndrome (SIRS).
Design:
Prospective study in a tertiary-care hospital.
Methods:
Consecutive pediatric patients admitted to the ward or pediatric intensive care unit (PICU) were studied. The respiratory rate, heart rate, capillary refill time, oxygen saturation (SpO2), systolic blood pressure and temperature were noted, Sensorium level was assessed on AVPU score. Variables were based on SIRS criteria and criteria mentioned in Advanced Pediatric Life Support (APLS). Each study variable was scored as 0 or 1 (normal or abnormal) and total score for each child obtained. The survival at discharge was correlated with the study variables and the total score. Another score based on the magnitudes of the coefficients in multiple logistic regression analysis was computed and the correlation between this score and mortality was also studied. ROC curve analysis was performed to see the overall predictive ability of the score as well as a cut off at which maximum discrimination occurred.
Results:
Of 1099 children studied, 44 died. Of the seven variables, only five variables were abnormal in the study subjects. Except heart rate and respiratory rate, all other variables and age showed significant association with survival status (P < 0.01). The mortality increased with increase in the number of abnormal variables: 0.4% 2.2% 6.1% 15.3% 19.4% and 29.4%for scores of 0,1,2,3,4 and 5 respectively and the linear trend was significant (P < 0.01). Mortality also increased with a decrease in age (P < 0.01). Children with a score of 2 or more (2 or more abnormal clinical variables) had significantly higher mortality as compared to those with no abnormal clinical variables (score = 0). Based on the regression coefficients, the maximum possible score was 9.8. Regression based score was found to predict survival status well. The area under the ROC curve was 0.887, indicating that overall 88.7% of the subjects could be predicted correctly. Maximum discrimination was observed at a score of 2.5 (sensitivity 84.1% specificity 82.2%).
Conclusion:
For triage scoring, any child with 2 or more abnormal clinical variables should be taken as serious that might lead to death. With a more detailed scoring, score of 2.5 can be taken as cut-off to select children who possibly need admission and closer observation.
Related Concept Videos
01:14SBAR II: Application of SBAR
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...
01:27Assessment of the Cardiovascular System III: Palpation
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above the...
01:30Acute Coronary Syndrome III: Diagnostic Studies