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Scoring system to assess disease severity in children
Insights
A new scoring system, the Pediatric Therapeutic and Diagnostic Intervention Score (PTDIS), accurately assesses pediatric intensive care unit (PICU) patient severity. This tool helps predict mortality risk based on interventions, aiding clinical decision-making.
Area of Science:
- Pediatrics
- Critical Care Medicine
- Medical Informatics
Background:
- Assessing disease severity in pediatric intensive care units (PICUs) is crucial for patient management and resource allocation.
- Existing scoring systems may not fully capture the impact of therapeutic and diagnostic interventions on outcomes.
Purpose of the Study:
- To develop and validate a novel scoring system, the Pediatric Therapeutic and Diagnostic Intervention Score (PTDIS), for assessing disease severity in PICU patients.
- To correlate the PTDIS with patient mortality and identify key interventions associated with adverse outcomes.
Main Methods:
- Retrospective chart review of 475 consecutive pediatric admissions to a multidisciplinary PICU.
- Identification and scoring of therapeutic and diagnostic interventions (TDI) based on their association with mortality.
- Calculation of the PTDIS for each patient and correlation with mortality, sex, age, and hospitalization duration.
Main Results:
- The PTDIS effectively stratified patients into severity groups with distinct mortality rates (e.g., >50% mortality for PTDIS > 36).
- A strong positive correlation was found between PTDIS and mortality (R = 0.7162, p < 0.0001).
- PTDIS was significantly higher in non-survivors (43.6) compared to survivors (15.2).
- Sepsis, CNS infections, burns, shock, coma, and post-resuscitation were associated with highest mortality and PTDIS.
Conclusions:
- The Pediatric Therapeutic and Diagnostic Intervention Score (PTDIS) is an effective tool for accurately assessing disease severity in PICU patients.
- PTDIS provides a valuable metric for predicting mortality risk and guiding clinical care in critically ill children.
- The system's focus on interventions offers a unique perspective on disease severity assessment.
Abstract:
A scoring system to assess disease severity in children, based on therapeutic and diagnostic interventions, is suggested. The charts of 475 consecutive admissions to a multidisciplinary pediatric intensive care unit (PICU) were reviewed and therapeutic and diagnostic interventions (TDI) associated with more than 20% mortality identified. These were scored: TDI associated with 20-30% mortality - 1 point; 31-40% - 2 points; 41-50% - 3 points and more than 51% - 4 points. According to these values, a Pediatric Therapeutic and Diagnostic Intervention Score (PTDIS) was calculated for each patient. The study population may be divided, according to PTDIS and mortality, into three groups: moderately severe disease associated with up to 2.7% mortality and PTDIS less than 20; severe disease associated with up to 25% mortality and PTDIS less than 35; critically ill patients with more than 50% mortality and PTDIS greater than 36. PTDIS in survivors was 15.2 +/- 0.6 (mean +/- SE) and 43.6 +/- 1.1 in non-survivors. Pearson's correlation between PTDIS and mortality was R = 0.7162 at a significance level of p less than 0.0001. PTDIS and mortality were not found to be significantly correlated with sex, age or duration of hospitalization in the Unit. Sepsis, central nervous system infections and burns were the primary diseases, and shock, coma and patients after cardiopulmonary resuscitation the indications for admission to the Unit, associated with the highest mortality and PTDIS. This study demonstrates the efficacy of the suggested PTDIS system in accurately assessing severity of disease in a PICU patient population.