Skip to content
Research Article Open access CC BY 4.0

Impact of Optimizing Critical Care Resources in Pediatric Surgery Patients

Nora Mohammed Seiam, Ahmed Hassan Nofal, Ahmed Ibrahim Harkan, Khaled Talaat Muhammad

Asian Journal of Pediatric Research · pp. 33–42 · Published 6 Feb 2023

10.9734/ajpr/2023/v11i1213

Abstract

Background: Prediction scores could help to timely identify patients at risk. More intense care monitoring outside the pediatric intensive care unit (PICU) could improve outcomes. These concepts of critical care without borders could be implemented shortly with local resources and improve patient safety. Predict more, do less in PICUs, and more in the ward. The aim of this work was to evaluate the impact of prediction scores for identification of postoperative high risk surgical patients and their need for pediatric intensive care unit admission. Methods: This prospective study was carried out on 40 pediatric patients. The studied patients were divided into three groups. LR Group: 14 cases with ASA = 1, 2 PEWS ≤ 2, pSOFA ≤ 7, LqSOFA < 2. IR Group: 10 cases with PEWS = 3, 4 pSOFA = 8 -11 HiR Group: 16 cases with ASA = 3 -5, PEWS ≥ 5, pSOFA ≥ 12, LqSOFA ≥ 2. American Society of Anaesthesiologists (ASA) scoring was obtained from each patient preop. The Pediatric Early Warning (PEWS) Scoring was obtained from each patient immediately postop. The Pediatric Sequential Organ Failure Assessment (pSOFA) Scoring was obtained from patients admitted to PICU on day 1 and day 7. Liverpool quick Sequential Organ Failure Assessment (LqSOFA) scoring was obtained from all patients on admission. Results: Regarding prognostic performance of different scores to predict mortality.  For ASA score: it was statistically significant with AUC = .882, cut off values > 3, sensitivity = 75%, specificity = 88.89%, PPV = 42.9% and NPV = 97%. -For PEW score: it was statistically significant with AUC = .892, cut off values > 5, sensitivity = 79%, specificity = 80.56%, PPV =30% and NPV = 96.7%.  -For pSOFA score: it was statistically significant with AUC = .931, cut off values > 14, sensitivity = 85%, specificity = 86.11%, PPV =37.5%, and NPV = 96.9%. All ASA, PEW, and pSOFA were statistically significant as univariate but none was significant as multivariate. Conclusions:  ASA score, pSOFA score and PEWS score were significant predictor to length of stay (>21 days). ASA score, PEW score and pSOFA score were significant as predictor to mortality. ASA score and PEWS score were highly significant as to predict PICU Admission postop. PEWS score was highly significant as to predict PICU Admission postop. ASA, PEWs, and pSOFA were predictors for LOS for more than 21 days, predictors of mortality and predictors for PICU admission Postop. Decreased platelets and increased WBCs, urea, creatinine, AST, and RBG were significant with HiR. LqSOFA is a simple variable bedside tool for identifying septic patients at high risk for poor outcomes.

Pediatric surgery critical care optimizing resources American Society of Anaesthesiologists (ASA) score Pediatric Early Warning (PEWS) score Pediatric Sequential Organ Failure Assessment (pSOFA) score Liverpool quick sequential organ failure assessment (LqSOFA) score

References (30)

  1. 1 The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) [DOI]
  2. 2 Descriptive statistics and normality tests for statistical data [DOI]
  3. 3 Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes [DOI]
  4. 4 The physiological structure of human C-reactive protein and its complex with phosphocholine [DOI]
  5. 5 The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) [DOI]
  6. 6 ASA class is a reliable independent predictor of medical complications and mortality following surgery [DOI]
  7. 7 A Manual of Laboratory and Diagnostic Tests
  8. 8 Sensitivity of the Pediatric Early Warning Score to Identify Patient Deterioration [DOI]
  9. 9 Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: a multicentre European cohort study [DOI]
  10. 10 Mosby's Diagnostic and Laboratory Test Reference [DOI]
  11. 11 Mortality of emergency general surgical patients and associations with hospital structures and processes [DOI]
  12. 12 Accuracy of quick Sequential Organ Failure Assessment (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria for predicting mortality in hospitalized patients with suspected infection: a meta-analysis of observational studies [DOI]
  13. 13 Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma [DOI]
  14. 14 Patient Variables Which May Predict Length of Stay and Hospital Costs in Elderly Patients With Hip Fracture [DOI]
  15. 15 Developing the Surveillance Algorithm for Detection of Failure to Recognize and Treat Severe Sepsis [DOI]
  16. 16 ICU admission after surgery: who benefits? [DOI]
  17. 17 Sequential organ failure assessment scoring and prediction of patient's outcome in Intensive Care Unit of a tertiary care hospital [DOI]
  18. 18 Paediatric sequential organ failure assessment (pSOFA) score: a new mortality prediction score in the paediatric intensive care unit [DOI]
  19. 19 Perioperative predictors of prolonged length of hospital stay following total knee arthroplasty: a retrospective study from a single center in China [DOI]
  20. 20 Point-of-Admission Serum Electrolyte Profile of Children less than Five Years Old with Dehydration due to Acute Diarrhoea [DOI]
  21. 21 Comparison of Pediatric Sequential Organ Failure Assessment and Pediatric Risk of Mortality III Score as Mortality Prediction in Pediatric Intensive Care Unit [DOI]
  22. 22 Adverse In-Hospital Events Are Associated With Increased In-Hospital Mortality and Length of Stay in Patients With or at Risk of Acute Respiratory Distress Syndrome [DOI]
  23. 23 Utility of qSOFA score in identifying patients at risk for poor outcome in Staphylococcus aureus bacteremia [DOI]
  24. 24 Surgical mortality score: Risk management tool for auditing surgical performance [DOI]
  25. 25 Correlation of APACHE II and SOFA scores with length of stay in various surgical intensive care units.
  26. 26 Pediatric early warning score as a prognostic indicator in critically ill children - a prospective study [DOI]
  27. 27 Simple, easily memorised "rules of thumb" for the rapid assessment of physiological compensation for respiratory acid-base disorders [DOI]
  28. 28 The ethics of interventional procedures for patients too ill for surgery [DOI]
  29. 29 Can the Pediatric Early Warning Score (PEWS) Predict Hospital Length of Stay? [DOI]
  30. 30 Prolonged mechanical ventilation predictors in patients undergoing liver transplantation [DOI]

Cited by 0

No indexed citations yet.

Related research

Article metrics

Real usage data collected on this platform.

42

Page views

0

PDF downloads

12

Outbound clicks

0

Citations

Views over time

Views by country

Approximate, from request IP at view time — not citizenship or institution. Countries with fewer than 5 views are grouped as "Other".

Traffic sources

Referring site, by host.

Views and downloads exclude known bots/crawlers. Citations combines this platform's own DOI-resolved index with each external source's own reported total — see Cited by above for individually listed citing works. Last refreshed 0 seconds ago.