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Derivation and Validation of the Critical Bronchiolitis Score for the PICU
Michael C Mount1, Xinge Ji2, Michael W Kattan2
1Division of Pediatric Critical Care Medicine, UH Rainbow Babies and Children's Hospital, Cleveland, OH.
Insights
A new Critical Bronchiolitis Score accurately predicts respiratory support duration and PICU stay for children with bronchiolitis. This score outperforms traditional mortality-based measures in critically ill pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Respiratory illness research
- Clinical score development
Background:
- Bronchiolitis is a common cause of pediatric intensive care unit (PICU) admission.
- Existing illness severity scores, often mortality-based, may not optimally predict resource utilization like respiratory support duration and PICU length of stay in bronchiolitis.
- A specific score is needed to better estimate clinical trajectories for critically ill children with bronchiolitis.
Purpose of the Study:
- To derive and internally validate a novel illness severity score tailored for bronchiolitis.
- To compare the performance of this new score against existing mortality-based scores in predicting respiratory support duration and PICU length of stay.
Main Methods:
- Retrospective analysis of 14,407 children under 2 years old with bronchiolitis admitted to 128 North American PICUs.
- Utilized the Virtual Pediatric Systems (VPS) database, extracting patient data at 12 hours post-PICU admission.
- Developed the Critical Bronchiolitis Score using stepwise backward selection of variables significantly associated with outcomes, and validated its performance against existing scores.
Main Results:
- The Critical Bronchiolitis Score incorporates twelve commonly available patient-level variables.
- The score demonstrated strong agreement between calculated and actual outcomes in the validation cohort.
- Significantly outperformed mortality-based scores in predicting both duration of ICU-level respiratory support and PICU length of stay, as measured by lower root mean squared error and mean absolute error.
Conclusions:
- The Critical Bronchiolitis Score is a validated tool that surpasses traditional mortality-based scores for predicting key resource utilization metrics in pediatric bronchiolitis.
- This score offers potential utility for enriching interventional trials and adjusting for illness severity in observational studies involving pediatric bronchiolitis.
- The Critical Bronchiolitis Score provides a more accurate measure of expected clinical course for critically ill infants and young children with bronchiolitis.
Objectives:
To derive and internally validate a bronchiolitis-specific illness severity score (the Critical Bronchiolitis Score) that out-performs mortality-based illness severity scores (e.g., Pediatric Risk of Mortality) in measuring expected duration of respiratory support and PICU length of stay for critically ill children with bronchiolitis.
Design:
Retrospective database study using the Virtual Pediatric Systems (VPS, LLC; Los Angeles, CA) database.
Setting:
One-hundred twenty-eight North-American PICUs.
Patients:
Fourteen-thousand four-hundred seven children less than 2 years old admitted to a contributing PICU with primary diagnosis of bronchiolitis and use of ICU-level respiratory support (defined as high-flow nasal cannula, noninvasive ventilation, invasive mechanical ventilation, or negative pressure ventilation) at 12 hours after PICU admission.
Interventions:
Patient-level variables available at 12 hours from PICU admission, duration of ICU-level respiratory support, and PICU length of stay data were extracted for analysis. After randomly dividing the cohort into derivation and validation groups, patient-level variables that were significantly associated with the study outcomes were selected in a stepwise backward fashion for inclusion in the final score. Score performance in the validation cohort was assessed using root mean squared error and mean absolute error, and performance was compared with that of existing PICU illness severity scores.
Measurements And Main Results:
Twelve commonly available patient-level variables were included in the Critical Bronchiolitis Score. Outcomes calculated with the score were similar to actual outcomes in the validation cohort. The Critical Bronchiolitis Score demonstrated a statistically significantly stronger association with duration of ICU-level respiratory support and PICU length of stay than mortality-based scores as measured by root mean squared error and mean absolute error.
Conclusions:
The Critical Bronchiolitis Score performed better than PICU mortality-based scores in measuring expected duration of ICU-level respiratory support and ICU length of stay. This score may have utility to enrich interventional trials and adjust for illness severity in observational studies in this very common PICU condition.
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