Initial Modified Pulmonary Index Score Predicts Hospital Length of Stay for Asthma Subjects Admitted to the Pediatric Intensive Care Unit

Abstract

BACKGROUND: Scoring systems are frequently used to assess the severity of pediatric asthma exacerbations. The modified pulmonary index score (MPIS) has been found to be highly correlated with length of stay (LOS) in the pediatric intensive care unit (PICU). We sought to evaluate the use of the MPIS to predict hospital LOS for patients admitted to our PICU. METHODS: We retrospectively reviewed the medical records of pediatric asthma subjects aged 2-17 y admitted to our PICU between June 2014 and November 2017. We divided subjects a priori into 3 groups (low: MPIS 0-5; medium: MPIS 6-9; high: MPIS 6 10) based upon each subject's first MPIS documented in the PICU. Hospital LOS, PICU LOS, time on continuous albuterol, and increased respiratory support were compared between groups. RESULTS: 143 subjects were included. There were no differences for demographics, medical history, cause of exacerbations, or mean heart rate between groups. There were significant differences between groups for mean breathing frequency (P < .001), S pO 2 (P 5 .01), and F IO 2 (P < .004). There were significant differences between groups for route of admission (P 5 .02), high-flow nasal cannula use (P < .001), and use of a helium-oxygen mixture (P < .001). There were significant differences between groups for median hospital LOS (1.2 vs 2.3 vs 3.4 d, P < .001), PICU LOS (0.39 vs 1.3 vs 2 d, P < .001), and time on continuous albuterol (7.4 vs 20.6 vs 34.7 h, P < .001). After adjusting for demographics and medical history, the incidence risk ratio for hospital LOS was 2.09 for PICU admission for an MPIS of 6-9 and 2.68 for an MPIS 6 10 when compared to an MPIS < 6. CONCLUSIONS: The MPIS thresholds used in our pathway appropriately predicted LOS in our cohort of subjects with asthma admitted to the PICU. Higher MPIS was associated with increased hospital LOS, PICU LOS, and time on continuous albuterol.

Asthma in paediatric intensive care in England residents: observational study

“…(vi) Asthma was a low-risk diagnosis in PIM2. We did not have access to predictive severity score which is asthma specific, for example the initial Modified Pulmonary Index Score (MPIS) 28 . (vii) Our data pertained to all admissions during PICU stay only and did not include pre or post-hospitalisations.…”

Development of a non‐contact 15‐second paediatric respiratory rate monitor using microwave radar and its clinical application

“…Respiratory rate (RR), one of three parameters of sepsis‐3, is recognised as an important predictive factor for severity of diseases such as asthma in children 1 . It predicts clinical deterioration more effectively compared with other vital signs 2 .…”

“…Respiratory rate (RR), one of three parameters of sepsis-3, is recognised as an important predictive factor for severity of diseases such as asthma in children. 1 It predicts clinical deterioration more effectively compared with other vital signs. 2 Despite the importance of RR and due to inconvenience of contact-type sensors, medical professionals mostly determine RR by visually counting number of thoracic motions per a minute in outpatient unit, notwithstanding its low measurement accuracy and reproducibility.…”

Using Predictive Scoring Systems for Asthma Exacerbations Could Help Safely Conserve Resources During the COVID-19 Pandemic

“…Several groups at different centers have published findings that the mPIS is predictive of LOS, correlates with disease severity, and is reproducible across groups of health care professionals, supporting the notion that the mPIS may, indeed, be a useful tool when treating pediatric patients experiencing asthma exacerbations. [2][3][4][5] However, the observations from these trials may not replicate well at other centers with different patient demographics and asthma exacerbation management protocols. More prospective, multicenter studies comparing the mPIS to other scoring systems are warranted.…”