How well do vital signs identify children with serious infections in paediatric emergency care? | Archives of Disease in Childhood

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How well do vital signs identify children with serious infections in paediatric emergency care?

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Vital Signs Monitoring For Severity-Of-Illness Assessment:
Shomi Raman
Published on: 3 August 2009

Published on: 3 August 2009
Vital Signs Monitoring For Severity-Of-Illness Assessment:
- Shomi Raman, Registrar
- Other Contributors:
  Anjima Basumatari, Jacob Puliyel
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 signs.
We have developed such a scoring system and t...
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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 signs.
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 against mortality.
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 shomieha@yahoo.co.in
Anjima Basumatari MD Senior Registrar anjimadas@rediffmail.com
Jacob Puliyel MRCP M Phil Consultant puliyel@gmail.com
St Stephens Hospital Delhi 110054
References
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- illness. J Postgrad Med. 2006;52:102-5.
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Conflict of Interest:
None declared.
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