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Thompson and colleagues have shown that commonly recorded vital signs
can be used to identify children with serious infections in the pediatric-
assessment-unit and that its sensitivity is comparable to more complicated
triage systems (1). However they did not take their study to the next
logical step of developing a scoring system for triage, using these vital
We have developed such a scoring system and t...
We have developed such a scoring system and the validation study done
concurrently in the UK and India was presented at the last annual meeting
of the British Pediatric Association (2). Called the ‘SICK Score’ (an
acronym for Signs of Inflammation in Children that can Kill), it uses the
physical variables of the systemic inflammatory response syndrome (SIRS)
and its continuum - the multiple organ dysfunction syndrome (MODS). Very
much like Thompson and colleagues, the parameters used by us were heart
rate, respiratory rate, systolic blood pressure (dichotomized as
normotensive and hypotensive), temperature, oxygen saturation, capillary
refill time and consciousness on the AVPU scale. The regression
coefficients (logs of the odds ratio of death) in the development-study
cohort, were used as weights for each parameter. Validation was done
The area under the ROC curve for the validation study done in UK and
India was 84.1% (95% CI: 77.5 to 90.7%) and this is comparable ROC of 77%
in the validation study of PRISM 2 (3). PRISM 2 was used as it is
available free in the public domain. In an earlier validation study we
tested ‘SICK Score against PRISM score in 125 patients who needed to be
admitted to the intensive care unit. The area under the ROC was 0.76 using
SICK Score and 0.78 using PRISM score. Hosmer-Lemeshow goodness of fit was
excellent. (Hosmer-Lemeshow Chi-square = 2.13 (P = 0.3450)) (4). The
software for calculation of SICK Score is available at
http://jacob.puliyel.com/sick.php. We agree with Thompson and colleagues
that vital signs by themselves can be as useful to assess severity of
illness in children seeking medical attention.
Shomi Raman DCH Registrar
Anjima Basumatari MD Senior Registrar
Jacob Puliyel MRCP M Phil
St Stephens Hospital
1. Thompson MJ, Coad N, Harnden A, Mayon-White R, Perera R, Mant D.
How well do vital signs identify children with serious infections in
paediatric emergency care?
Arch Dis Child published 15 July 2009, 10.1136/adc.2009.159095.
2. Gupta MA, Sahni M, Puliyel JM, Rangasami J, Chakrabarti A,
Halstead R, Green DA, Puliyel A, Sreenivas V. International collaboration
validating SICK score: a non-invasive severity-of-illness assessment. Arch
Dis Child 2008;93 (Suppl 1) A10.
3. Chamberlain JM, Patel KM, Pollack MM. The Pediatric risk of
hospital admission score: A second-generation severity-of-illness score
for pediatric emergency patients. Pediatrics. 2005;115:388-396.
4. Bhal S, Tygai V, Kumar N, Sreenivas V, Puliyel JM. Signs of
inflammation in children that can kill (SICK score): Preliminary
prospective validation of a new non-invasive measure of severity-of-
J Postgrad Med. 2006;52:102-5.