Clinician Accuracy in Identifying and Predicting Organ Dysfunction in Critically Ill Children

Carlton, Erin; Close, Jeylan; Paice, Kelli; Dews, A.; Gorga, Stephen M; Sturza, Julie; Barbaro, Ryan P.; Cornell, Timothy T.; Prescott, Hallie C.

doi:10.1097/ccm.0000000000004555

Cited by 5 publications

(4 citation statements)

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“…A prospective, observational convenience cohort of patients admitted to a PICU at a tertiary care children’s hospital from March 2017 through August 2018 was evaluated, as part of a larger study of clinician identification and prediction of multiple organ dysfunction syndrome in children [ 24 ]. All patients included in the parent study period had an expected length of stay greater than 2 days at admission determined by a member of the care team as previously described.…”

Section: Methodsmentioning

confidence: 99%

Renal angina index predicts fluid overload in critically ill children: an observational cohort study

et al. 2021

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Background Fluid overload and acute kidney injury are common and associated with poor outcomes among critically ill children. The prodrome of renal angina stratifies patients by risk for severe acute kidney injury, but the predictive discrimination for fluid overload is unknown. Methods Post-hoc analysis of patients admitted to a tertiary care pediatric intensive care unit (PICU). The primary outcome was the performance of renal angina fulfillment on day of ICU admission to predict fluid overload ≥15% on Day 3. Results 77/139 children (55%) fulfilled renal angina (RA+). After adjusting for covariates, RA+ was associated with increased odds of fluid overload on Day 3 (adjusted odds ratio (aOR) 5.1, 95% CI 1.23–21.2, p = 0.025, versus RA-). RA- resulted in a 90% negative predictive value for fluid overload on Day 3. Median fluid overload was significantly higher in RA+ patients with severe acute kidney injury compared to RA+ patients without severe acute kidney injury (% fluid overload on Day 3: 8.8% vs. 0.73%, p = 0.002). Conclusion Among critically ill children, fulfillment of renal angina was associated with increased odds of fluid overload versus the absence of renal angina and a higher fluid overload among patients who developed acute kidney injury. Renal angina directed risk classification may identify patients at highest risk for fluid accumulation. Expanded study in larger populations is warranted.

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Section: Methodsmentioning

confidence: 99%

Renal angina index predicts fluid overload in critically ill children: an observational cohort study

et al. 2021

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“…The most common reason for admission was respiratory failure or distress (76/259, 29%) and postoperative monitoring and support (64/259, 25%). The median PICU day on which providers estimated fluid administration was 8 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: Resultsmentioning

confidence: 99%

“…Surveys were administered after team rounds to ensure that team decision-making had occurred on that day, similar to prior studies. 14 15 17 During completion of the survey, clinicians were able to access the age and weight of the patient, but no other clinical data could be accessed. Each survey took less than 1 minute to complete.…”

Section: Methodsmentioning

confidence: 99%

Variability in Clinician Awareness of Intravenous Fluid Administration in Critical Illness: A Prospective Cohort Study

Gorga

SLIWICKI

Sturza

et al. 2022

J Pediatr Intensive Care

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Intravenous (IV) fluids are commonly administered to critically ill children, but clinicians lack effective guidance for the correct dose and duration of therapy resulting in variation of prescribing habits which harm children. It is unknown if clinicians recognize the amount of IV fluid that patients receive. We aimed to determine clinician's accuracy in the identification of the volume of IV fluids patients will receive over the next 24 hours. Prospective cohort study enrolled all patients admitted to the pediatric intensive care unit (PICU) from May to August 2021 at the University of Michigan's C.S. Mott Children's Hospital PICU. For each patient, clinicians estimated the volume of IV fluid that patients will receive in the next 24 hours. The primary outcome was accuracy of the estimation defined as predicted volume of IV fluids versus actual volume administered within 10 mL/kg or 500 mL depending on patient's weight. We tested for differences in accuracy by clinician type using chi-square tests. There were 259 patients for whom 2,295 surveys were completed by 177 clinicians. Clinicians' estimates were accurate 48.8% of the time with a median difference of 10 (1–26) mL/kg. We found that accuracy varied between clinician type: bedside nurses were most accurate at 64.3%, and attendings were least accurate at 30.5%. PICU clinicians have poor recognition of the amount of IV fluids their patients will receive in the subsequent 24-hour period. Estimate accuracy varied by clinician's role and improved over time, which may suggest opportunities for improvement.

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“…Насколько стоит доверять прогнозу при СПОН? Считается, что точность прогнозирования СПОН в общепопуляционном плане является достаточно высокой, однако исследование E.F. Carlton показало подводные камни данного суждения [6]. Опрос врачей ОРИТ продемонстрировал, что клиницисты предсказывали развитие и прогрессирование СПОН с точностью 80%, однако он развился только у 8% пациентов, поэтому точность во многом была обусловлена истинно отрицательными прогнозами.…”

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Multiple organ dysfunction syndrome prediction in newborn children

Golomidov¹,

Grigoryev

Мозес

et al. 2022

Innovacionnaâ medicina Kubani

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There are several directions for predicting multiple organ dysfunction syndrome (MODS), but almost all of them are poorly tested in neonatology. This review is presented to indicate the problem of the condition severity objectification of newborns and the possibility of predicting the development of MODS. Scales for assessing the severity of MODS in critically ill children have been developed and used since the end of the last century, but their validation in the newborns faces certain difficulties. Prognostic nosospecific scales: NICHD (National Institute of Child Health and Human Development) calculator, CRIB II (Clinical Risk Index for Babies), SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal Extension II) are used in neonatology, however their comparison in this category of patients has not been carried out.Theoretical and practical issues of the short-term and long-term prediction of the MODS onset and its outcomes in newborns is a promising area of neonatology, since it allows a doctor to be warned about an impending catastrophe and opens a “window of opportunity” for timely correction of treatment tactics and complications prevention. Obtaining different phenotypes of critical illness and predicting their outcomes in children may have good predictive potential, but such studies have not been conducted in newborns. A promising direction in predicting MODS is the identification of biomarkers of inflammation, among which endocan, cluster of differentiation 64, cluster of differentiation molecules 11b, “pancreatic stone protein” (PSP), soluble intercellular adhesionmolecule-1 (sICAM-1), progranulin, neopterin, resistin (FIZZ3, presepsin (PSP)) carry a good potential, but their effectiveness in neonatology is still to be investigated.Thus, the prediction of MODS in children and newborns remains an unresolved problem. At the same time, several promising scientific directions are actively being developed today, which may lead to a significant breakthrough in predicting MODS in neonatology.

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Clinician Accuracy in Identifying and Predicting Organ Dysfunction in Critically Ill Children

Abstract: Objective: To determine clinician accuracy in the identification and prediction of multiple organ dysfunction syndrome (MODS).

Cited by 5 publications

References 40 publications

Renal angina index predicts fluid overload in critically ill children: an observational cohort study

Renal angina index predicts fluid overload in critically ill children: an observational cohort study

Variability in Clinician Awareness of Intravenous Fluid Administration in Critical Illness: A Prospective Cohort Study

Multiple organ dysfunction syndrome prediction in newborn children

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