Related Experiment Video
Updated: Dec 9, 2025
How to Administer Near-Infrared Spectroscopy in Critically ill Neonates, Infants, and Children
Published on: August 19, 2020
Criticality: A New Concept of Severity of Illness for Hospitalized Children
Eduardo A Trujillo Rivera1, Anita K Patel2, James M Chamberlain3
1George Washington University School of Medicine and Health Sciences, Washington, DC.
Insights
A new Criticality Index accurately measures pediatric inpatient severity using physiology and therapy data. This tool helps predict future care needs for hospitalized children.
Area of Science:
- Pediatric critical care medicine
- Health informatics
- Machine learning in healthcare
Background:
- Assessing pediatric inpatient severity is complex.
- Existing measures may not fully capture nuances of care intensity.
- A novel approach is needed to quantify pediatric patient acuity.
Purpose of the Study:
- To validate the conceptual framework of "criticality" as a pediatric inpatient severity measure.
- To operationalize criticality using physiology, therapy, and therapeutic intensity.
- To calibrate the measure against intensive care unit (ICU) care.
Main Methods:
- Deep neural network analysis of a national pediatric database (Health Facts).
- Utilized laboratory tests, vital signs, and medication data.
- Modeled care intensity (ICU vs. routine care) every 6 hours.
Main Results:
- The Criticality Index demonstrated excellent separation of severity hierarchies.
- Achieved high performance metrics: AUC 0.95, sensitivity 0.817, specificity 0.892.
- 88% of Criticality Indices correctly reflected higher intensity care locations.
Conclusions:
- The Criticality Index quantifies pediatric severity using physiology, therapy, and care intensity.
- This novel conceptual model is applicable to clinical investigations.
- The index can aid in predicting future healthcare needs for hospitalized children.
Objectives:
To validate the conceptual framework of "criticality," a new pediatric inpatient severity measure based on physiology, therapy, and therapeutic intensity calibrated to care intensity, operationalized as ICU care.
Design:
Deep neural network analysis of a pediatric cohort from the Health Facts (Cerner Corporation, Kansas City, MO) national database.
Setting:
Hospitals with pediatric routine inpatient and ICU care.
Patients:
Children cared for in the ICU (n = 20,014) and in routine care units without an ICU admission (n = 20,130) from 2009 to 2016. All patients had laboratory, vital sign, and medication data.
Interventions:
None.
Measurements And Main Results:
A calibrated, deep neural network used physiology (laboratory tests and vital signs), therapy (medications), and therapeutic intensity (number of physiology tests and medications) to model care intensity, operationalized as ICU (versus routine) care every 6 hours of a patient's hospital course. The probability of ICU care is termed the Criticality Index. First, the model demonstrated excellent separation of criticality distributions from a severity hierarchy of five patient groups: routine care, routine care for those who also received ICU care, transition from routine to ICU care, ICU care, and high-intensity ICU care. Second, model performance assessed with statistical metrics was excellent with an area under the curve for the receiver operating characteristic of 0.95 for 327,189 6-hour time periods, excellent calibration, sensitivity of 0.817, specificity of 0.892, accuracy of 0.866, and precision of 0.799. Third, the performance in individual patients with greater than one care designation indicated as 88.03% (95% CI, 87.72-88.34) of the Criticality Indices in the more intensive locations was higher than the less intense locations.
Conclusions:
The Criticality Index is a quantification of severity of illness for hospitalized children using physiology, therapy, and care intensity. This new conceptual model is applicable to clinical investigations and predicting future care needs.
More Related Videos
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:29Drug Dosing: Infants and Children
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:22Acute Kidney Injury I: Introduction