Related Experiment Videos
[Objective evaluation of a pediatric intensive care unit without continuous attendance (I)]
V Bolívar Galiano1, N Palomino Urda, P Azcón González de Aguilar
1Departamento de Pediatría, Hospital Materno-Infantil, Ciudad Sanitaria Virgen de las Nieves, Granada.
Insights
This study on ICU admissions found that 28% were severe (grade IV), with mortality correlating better with the PIM2 Score (PSI) than the Therapeutic Intervention Scoring System (TISS). Objective evaluation methods are recommended.
Area of Science:
- Critical Care Medicine
- Health Services Research
Context:
- Analysis of 809 ICU admissions using record cards.
- Inclusion of Therapeutic Intervention Scoring System (TISS) and Pediatric Index of Mortality 2 (PIM2) Score (PSI) data from the first six hours.
- Assessment of patient severity and resource utilization.
Purpose:
- To reexamine ICU admission data.
- To evaluate the correlation between patient severity scores (PSI and TISS) and mortality.
- To identify potential deficiencies in patient assessment methodologies.
Summary:
- 50% of admissions were medium care (PSI < 5, TISS < 20).
- 28% were classified as grade IV (PSI > 12, TISS > 40).
- Overall mortality was 8.9%, with grades III+IV at 13.4%.
- PSI showed good correlation with mortality, TISS did not.
- A deficient PSI/TISS ratio was observed (0.45).
Impact:
- Highlights the prevalence of severe cases (grade IV) in ICU admissions.
- Suggests PSI is a more reliable predictor of mortality than TISS in this cohort.
- Recommends objective evaluation methods for ICU patient assessment, considering methodology capabilities.
Abstract:
Eight-hundred and nine consecutive admissions have been reexamined by means of analysis of record cards made out at the moment of discharge from the ICU, in which, among other data, the TISS and PSI maximum for the first six hours from admission are included. The results obtained are the following: 50% of the admissions were classified as medium care (PSI < 5, TISS < 20), 28% were grade IV (PSI > 12, TISS > 40), and half were of grade III with a PSI of 9.38 and a TISS of 20.29. The overall mortality was 8.9%. However, the mortality for grades III+IV was 13.4% and gave a good correlation with the PSI, but not with the TISS. The PSI/TISS ratio was 0.45 and the predicted mortality rate according to the PSI was 6.1% for grade III and greater than 12% for grade IV. We conclude the following: (1) Of the illness, 28% were grade IV. (2) We observed a deficient PSI/TISS ratio. (3) The evaluation has to be done by objective means in which the capability of carrying out different methodologies has not been taken into account.