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The admission cardiorespiratory performance in relation to outcome in pediatric ICU patients
1Pediatric Intensive Care Unit, Chaim Sheba Medical Center, Tel Aviv, Israel.
Insights
The "Rule of 60" cardiorespiratory score effectively predicts outcomes in pediatric intensive care unit (PICU) patients. Higher scores indicate increased severity and mortality risk, aiding in patient prognostication.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiorespiratory Physiology
- Clinical Outcomes Research
Background:
- Admission cardiorespiratory performance is crucial for predicting outcomes in pediatric intensive care unit (PICU) patients.
- Existing scoring systems may not fully capture the nuances of cardiorespiratory status in diverse PICU populations.
- A simple, effective scoring system is needed to stratify risk and guide management.
Purpose of the Study:
- To test the hypothesis that admission cardiorespiratory performance, assessed by the
- Rule of 60
- (RO60) scoring system, determines patient outcomes in the PICU.
- To evaluate the RO60 system's ability to predict mortality across different clinical entities.
- To compare the RO60 system's prognostic accuracy with the Glasgow Coma Scale in head trauma patients.
Main Methods:
- A prospective study of 331 pediatric patients admitted to the PICU, categorized into respiratory disease, cardiovascular disease, and head trauma groups.
- Utilized the novel
- Rule of 60
- (RO60) scoring system, evaluating 6 cardiorespiratory parameters with a cut-off of 60 for risk assignment (0 or 10 points).
- Assessed the highest RO60 score within the first 24 hours of PICU admission to determine severity levels (A: 0-30, B: 40-60) and associated mortality rates.
Main Results:
- A significant positive correlation was observed between RO60 scores and mortality rates.
- Severity Level A patients (scores 0-30) had a low mortality rate (2%-5%), while Level B patients (scores 40-60) faced significantly higher mortality (30%-80%).
- Overall mortality rates were 2% for Level A and 54% for Level B. Patients with respiratory disease in Level B had the lowest mortality (20%) compared to cardiovascular disease (52%) and head trauma (80%).
Conclusions:
- The
- Rule of 60
- (RO60) cardiorespiratory scoring system is a reliable predictor of mortality in PICU patients.
- The RO60 system effectively stratifies patients into distinct risk categories, aiding in prognostication.
- The RO60 system demonstrated comparable prognostic accuracy to the Glasgow Coma Scale for head trauma patients.
Abstract:
We tested the hypothesis that the admission cardiorespiratory performance determines the outcome in pediatric intensive care unit (PICU) patients. We studied 331 patients who were assigned to one of the three commonly encountered PICU clinical entities: respiratory disease, cardiovascular disease and head trauma. All patients were evaluated by a simple cardiorespiratory scoring system which we named "Rule of 60" (RO60), and their highest score within the first 24 h of arrival in the PICU was used for the study. This scoring system includes 6 cardiorespiratory parameters where a value of 60 represents a cut-off point above or below which 0 points (low risk) or 10 points (high risk) are assigned. The relationship between score and mortality rate revealed that the higher the score the higher is the mortality rate. We determined two categories of severity of illness in our patients. Patients at severity level A had scores ranging from 0 through 30 and the mortality rate in this category ranged from 2% to 5%. Patients at severity level B had scores ranging from 40 through 60 and had a higher mortality rate: 30% to 80%. The overall mortality rates for patients at severity level A and B were 2% and 54% respectively. Patients with respiratory disease at severity level B had the lowest mortality rate (20%), whereas patients with cardiovascular disease and head trauma had mortality rates of 52% and 80% respectively. We found that our cardiorespiratory scoring system was as good as the Glasgow Coma Scale for indicating prognosis and outcome in head trauma patients.(ABSTRACT TRUNCATED AT 250 WORDS)