G125. THE DEVELOPMENT OF THE PAEDIATRIC HEPATOLOGY DEPENDENCY SCORE—AN AUDIT TOOL

A.D. Cowley, S.V. Beath, C. Cummins², D. Porter, I. van Mourik, P.J. McKiernan, D.A. Kelly.

The Liver Unit and ² Statistics Dept, Birmingham Childen’s Hospital, Steelhouse Lane, Birmingham, B4 6NH

Aims: To develop an audit tool, which measures disease severity and clinical dependency in children with liver disease.

Methods: The initial score was based on known prognostic variables (J Malatack, et al) used in acute and chronic liver disease. Between 1997 and 2001 the score was modified four times and reduced to comprise 10 key variables as follows: Aspartate transaminase, prothrombin time, albumin, bilirubin, ascites, nutrition, organ dysfunction, blood product support, sepsis and IV access. The first five parameters are specific to liver disease and the last five are generic dependency parameters. The score was validated by examining 1) face validity, 2) construct validity, 3) internal consistency (Cronbach’s Alpha). Inter-observer differences were evaluated by the methods of Bland and Altman.

Results: The final 10 variable score was tested on 132 (all children admitted to the ward over two 3 month periods). The score was valid and internally consistent. The Cronbach’s Alpha score for the total score was 0.72. It has good construct validity and correlated with the length of stay (Spearman’s correlation, 0.731 significant at 0.01 level). There was also a significant correlation between the liver and dependency score (P<0.01). The score was easy to collect, reproducible and the inter-observer error was acceptable.

Conclusion: The PHD Score is valid and internally consistent and has the capacity to measure disease severity and dependency prospectively. It is now being recorded on all summaries in order to facilitate departmental audit.

Acknowledgement: We are grateful to D. Sandhu, C. Lloyd and C. Weijers for their help.

G126. IMPROVEMENT IN THE QUALITY OF CLINICAL DECISION MAKING IN AN ACUTE SETTING: IMPACT OF A WEB-BASED DIFFERENTIAL DIAGNOSIS TOOL (ISABEL)

P. Ramnarayan, A. Tomlinson, G. Roberts, M. Coren, V. Nanduri¹, T. Sajjanhar², …