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Validation of two scoring systems which assess the degree of physiologic instability in critically ill newborn
M K Georgieff1, M M Mills, P Bhatt
1Department of Pediatrics, University of Minnesota Hospital and Clinic, Minneapolis 55455.
Insights
Modified Physiologic Stability Index (PSI) and Therapeutic Intervention Scoring System (TISS) effectively measure newborn infant stability and intervention needs. These scores predict longer recovery times and nutritional risks in the neonatal intensive care unit.
Area of Science:
- Neonatal Physiology
- Critical Care Medicine
- Pediatric Health
Background:
- Assessing physiologic stability and intervention needs in neonatal intensive care units (NICUs) is crucial.
- Existing scoring systems may require adaptation for the unique physiology of neonates.
Purpose of the Study:
- To evaluate the utility of modified Physiologic Stability Index (PSI) and Therapeutic Intervention Scoring System (TISS) in a neonatal intensive care unit.
- To determine the correlation between these modified scores and patient outcomes, including nutritional status.
Main Methods:
- Modified the PSI to better reflect neonatal physiology.
- Correlated PSI and TISS scores with each other and with the Nursing Utilization Management Intervention System (NUMIS) classifications.
- Analyzed score changes over time (admission to discharge/day 14) and between different disease states (hyaline membrane disease vs. transient tachypnea).
Main Results:
- Modified PSI scores showed significant correlations with TISS (r = .75) and NUMIS (r = .62) values.
- Both PSI and TISS scores significantly decreased from admission to discharge or day 14.
- Higher initial PSI and TISS scores were associated with longer time to adequate protein-calorie intake and increased risk for nutritional morbidity.
Conclusions:
- The modified PSI and TISS are valuable, objective tools for assessing physiologic instability in critically ill newborns.
- These scoring systems can identify neonates at higher risk for nutritional complications, aiding in targeted interventions.
Abstract:
Modifications of the Physiologic Stability Index (PSI) and Therapeutic Intervention Scoring System (TISS) were used to evaluate the physiologic stability and need for therapeutic intervention in 55 infants hospitalized in the newborn ICU. After modifying the PSI to reflect neonatal physiology, we found that PSI scores correlated significantly with TISS values (r = .75, p less than .001) and Nursing Utilization Management Intervention System (NUMIS) classifications (r = .62, p less than .001). TISS values also correlated with NUMIS scores (r = .72, p less than .001). PSI and TISS scores increased significantly with each increase in NUMIS classification (p less than .001 for all comparisons). PSI and TISS scores decreased significantly between admission and either discharge (n = 41) or day 14 of hospitalization (n = 14, p less than .001). PSI and TISS scores were greater on days 1 and 5 in infants with hyaline membrane disease when compared with infants with transient tachypnea (p less than .001). Infants with PSI scores greater than or equal to 4 and TISS scores greater than or equal to 7 on day 1 took significantly longer to achieve adequate protein-calorie intakes than infants with lower first-day scores (p less than .002). The modified PSI and the TISS scoring systems are both useful objective measurements of the degree of physiologic instability in newborn infants requiring intensive care, and both scores identify those at increased risk for nutritional morbidity.