You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

The Ideal Time Interval for Critical Care Severity-of-Illness Assessment

Pollack, Murray M. MD1; Dean, J. Michael MD2; Butler, Jerry MS2; Holubkov, Richard PhD2; Doctor, Allan MD3; Meert, Kathleen L. MD4; Newth, Christopher J. L. MD, FRCPC5; Berg, Robert A. MD6; Moler, Frank MD7; Dalton, Heidi MD8; Wessel, David L. MD9; Berger, John MD9; Harrison, Rick E. MD10; Carcillo, Joseph A. MD11; Shanley, Thomas P. MD7; Nicholson, Carol E. MD12

Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e31828a7270
Feature Articles
SCCM Podcast
Abstract

Objective: Determine if the shortest sampling interval for laboratory variables used to estimate baseline severity of illness in pediatric critical care is equivalently sensitive across multiple sites without site-specific bias, while accounting for the vast majority of dysfunction compared with the standard 0- to 12-hour Pediatric Risk of Mortality III score.

Design: Prospective random patient selection.

Setting: General/medical and cardiac/cardiovascular PICUs in eight hospitals.

Patients: Patients younger than 18 years admitted to the PICU.

Interventions: None.

Measurements and Main Results: A total of 376 patients were included. Measurements for Pediatric Risk of Mortality III laboratory variables (pH, PCO2, total CO2, PaO2, glucose, potassium, blood urea nitrogen, creatinine, total WBC count, platelet count, and prothrombin time/partial thromboplastin time) were recorded from 2 hours prior to PICU admission through 12 hours of PICU care except for data in the operating room. Decreasing the observation period from 0 to 12 hours post-PICU admission resulted in progressive decreases in the Pediatric Risk of Mortality III laboratory variables measured. However, allowing the observation period to start 2 hours prior to PICU admission to 4 hours reduced this loss to only 3.4%. Similar trends existed for each of the individual laboratory Pediatric Risk of Mortality III variables. There was a nearly identical distribution of laboratory Pediatric Risk of Mortality III points within the –2- to 4-hour period compared with the standard period. We did not detect any institutional bias using the –2- to 4-hour time period compared with the baseline.

Conclusions: Prognostically important laboratory physiologic data collected within the interval from 2 hours prior to PICU to admission through 4 hours after admission account for the vast majority of dysfunction that these variables would contribute to Pediatric Risk of Mortality III scores. There was no institutional bias associated with this sampling period.

Author Information

1Department of Child Health, Phoenix Children’s Hospital and University of Arizona College of Medicine-Phoenix, Phoenix, AZ.

2Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.

3Departments of Pediatrics and Biochemistry, Washington University School of Medicine, St. Louis, MO.

4Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI.

5Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA.

6Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA.

7Department of Pediatrics, University of Michigan, Ann Arbor, MI.

8Department of Child Health, Phoenix Children’s Hospital and University of Arizona College of Medicine-Phoenix, Phoenix, AZ.

9Department of Pediatrics, Children’s National Medical Center, Washington, DC.

10Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA.

11Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, PA.

12The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD.

Supported, in part, by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD.

Dr. Doctor consulted for TerumoBCT, iNO Therapeutics, Galleon Pharmaceuticals, Nitrox, and has patents with Nitrox. Dr. Berger received grant support from Actelion (grant for enrolling research subjects in unrelated area). Dr. Harrison received grant support from the University of Michigan and payment for lectures from UCLA Department of Pediatrics, Society of Critical Care Medicine. Dr. Shanley provides expert testimony to Sandberg, Phoenix & Von Gontard PC. Dr. Nicholson is employed by the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: mpollack@phoenixchildrens.com

©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies