Pediatric risk of Mortality III (PRISMIII) score as a predictor of mortality in PICU, Institute of Child Health and Hospital for Children, Egmore

Thiyagu, G (2006) Pediatric risk of Mortality III (PRISMIII) score as a predictor of mortality in PICU, Institute of Child Health and Hospital for Children, Egmore. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Prognostication has always been the duty of a physician. This is perhaps particularly true in the case of critically ill patients. With progress in all specialities in pediatrics, pediatric critical care has also developed tremendously. Nowadays Pediatric intensive care units are becoming increasingly sophisticated in terms of equipment used and the types of therapy administered in various acute illnesses. The evaluation and prognostication of all cases admitted to the Pediatric Intensive Care Unit (PICU) is important for various reasons. Scoring systems aim at providing an objective measure of the severity and hence the prognosis of patients. They are also important for medical audit and in the comparison of cohorts of patients entering clinical trials. A scoring system is also a tool in resource management. It helps in allocation of limited PICU facilities and provides an index for the level of intervention appropriate for that patient. The PRISM III score is one of the most recent scoring systems of pediatric mortality. The outcome of pediatric intensive care has not been widely reported in India and few studies describe the use and validation of any scoring system. This study aims at using the PRISM III score in a PICU in a tertiary referral hospital in India to evaluate its usefulness. OBJECTIVES: Primary: To validate the usefulness of PRISM III score in predicting mortality in a Pediatric Intensive Care Unit in Tamilnadu government tertiary care hospital setting. Secondary: To assess the factors contributing to mortality such as need for assisted ventilation, presence of shock and poor Glasgow Coma Scale (GCS). METHODOLOGY: Study Design: This study is a descriptive study to validate a diagnostic scoring system namely, PRISM III. Study Place: Pediatric Intensive Care Unit (PICU), Institute of Child Health and Hospital for Children (ICH & HC), Chennai Sample Size: Annually, 900- 1000 children are admitted in PICU, Institute of Child Health with a mortality rate of 30-40 %. For an expected sensitivity of 85%, for the PRRISM III score to predict mortality, 119 patients need to be studied. EPIINFO software was used for calculating the sample size. Duration: Total duration of the study was 18 months starting from June 2004. Protocol was prepared for 3 months. Study was conducted for the next one year followed by, analysis for 3 months. Inclusion Criteria: All patients admitted into PICU, Institute of Child Health and Hospital for Children, Egmore, Chennai. Exclusion Criteria: 1. Patients in ICU for less than 2 hours (e.g. shifted to ICU for observation). 2. Age less than 1 month. 3. Presence of multiple congenital anomalies. 4. Patients admitted with continuous CPR who do not achieve stable vital signs for > 2 hours. CONCLUSIONS: • PRISM III score provides an objective assessment of the severity of illness. • PRISM III performed well as a tool to predict mortality in an Indian PICU. • Scoring systems with fewer laboratory parameters will be more useful in our Context. • Larger studies are needed to develop/ validate a mortality prediction score for our country.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Pediatric risk of Mortality III (PRISMIII) score ; predictor of mortality ; PICU ; Institute of Child Health and Hospital for Children ; Egmore.
Subjects: MEDICAL > Paediatrics
Depositing User: Punitha K
Date Deposited: 07 Jul 2017 07:44
Last Modified: 23 Jul 2018 01:36
URI: http://repository-tnmgrmu.ac.in/id/eprint/1225

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