PICU PERFORMANCE AND OUTCOME SCORES

3. PICU PERFORMANCE AND OUTCOME SCORES Prof. Dr. Reda Sanad Arafa Professor of Pediatrics Faculty of Medicine Benha University EGYPT Benha Faculty Of Medicine - EGYPT

4. INTENSIVE CARE UNIT Benha Faculty Of Medicine - EGYPT

5. IMPORTANCE OF PICU • Pediatric intensive care unit (PICU) is an important component of tertiary pediatric care services. • PICU aims at promoting qualified care for critically ill children . • These units are points of majortechnologytransfer and constitute one of the main consumers of hospital budgets. • Lakshmi (2008) reported that 15-20 % of hospital budgets are spent in ICUs • Abdul-Monim B (2001) reported that ICUs consume : • 10% of hospital beds • 30% of acute care hospital cost • > 20% of hospital budgets Benha Faculty Of Medicine - EGYPT

6. Critically ill child Benha Faculty Of Medicine - EGYPT

7. Critically ill child means a child who is in a clinical state which may result in respiratory or cardiac arrest or severe neurologic complication . • Risk for critical illness may be primary cardiovascular or respiratory or secondary to neurologic , infectious , metabolic disorder or serious injury . • Infection is the most common & septic shock is a catastrophic immune system reaction which produce organ failure . • ( Emma W., 2009 ) (Qureshi et al.; 2007) Benha Faculty Of Medicine - EGYPT

8. PATHWAY OF DETERIORATION IN CRITICAL ILLNESS

9. SEQUELAE OF INFECTION IN CRITICALY ILL CHILD (Stormorken & Powell, 2004)

10. MULTIPLE ORGAN DYSFUNCTION SYNDROME IN CHILDREN (MODS) • The simultaneous occurrence of at least two organ failure. • MODS is important because of its frequent occurrence and its association with high mortality in the pediatric intensive care unit • 25% of the children admitted to PICU has MODS and that the mortality associated with it is up to 50%. • In fact, from 97% to 100% of the deaths in PICUs have been related to MODS. ( Marshall et al., 2003) Benha Faculty Of Medicine - EGYPT

11. Benha Faculty Of Medicine - EGYPT

12. Quality Monitoring in PICU • Estimation ofdisease severity and probability of death are important elements in determining the prognosis of patients in PICU. • A more accurate prognostic assessment can lead to more appropriate monitoring , proper management and family counseling. • ICU scoring systems are devised to determine probable outcome of the patients admitted to the ICU ( Marshall et al., 2003) Benha Faculty Of Medicine - EGYPT

13. PICU outcome scoring • The most commonly measured PICU outcomes are mortality, length of stay, functional outcome, and organ dysfunction . • The 2 most commonly used scoring systems to predict ICU mortality are the Pediatric Risk of Mortality (PRISM)and the Pediatric Index of Mortality(PIM) . • Pediatric Logistic Organ Dysfunction (PELOD)has recently been validated with good discrimination. (Qureshi et al., 2007)

14. Scoring systems in PICU Benha Faculty Of Medicine - EGYPT

15. Scoring Systems in ICU • The Clinical Classification System ( CCS ) and the Therapeutic Intervention System ( TISS ) are indirect measures of illness severity . • The CCS is a qualitative assessment of care requirements on admission and the TISS is a quantitative measure of therapeutic requirements. Benha Faculty Of Medicine - EGYPT

16. The Physiologic Stability Index ( PSI ) is a more direct measure of illness severity but is time consuming , requiring the use of 34 variables. • The Pediatric Risk of Mortality ( PRISM ) was developed from the PSI to reduce the number of variables to 14 without losing its predictive power. • Pediatric Logistic Organ Dysfunction (PELOD) has recently been validated with good discrimination. (Qureshi et al., 2007) Benha Faculty Of Medicine - EGYPT

17. THE PELOD SCORE • The PELOD score has developed to estimate disease severity and probability of death for ICU patients . • It includes six key organ dysfunctions : cardiovascular, respiratory, hematological, neurological, renal, and hepatic. The maximum number of points for an organ dysfunction is 20 and the maximum PELOD score is 71. The total score gives us the percentage of probability of death PELOD Score.htmTable.doc Benha Faculty Of Medicine - EGYPT

18. Case study • A case of Down syndrome , 15 months old , 7.8 kg , with C H D common A V canal , complicated by bronchopneumonia & referred to PICU by : • RD grade IV • Shock • Drowsiness Benha Faculty Of Medicine - EGYPT

19. RD grade IV Tachypnea R R 78/min Nasal flare & retractions Cyanosis ( PaO2 58 mmHg ) • Shock Tachycardia 200/min Hypotension 52/35 Cold extremities Oliguria ( S.creat. 1.8 mg/dl ) Benha Faculty Of Medicine - EGYPT

20. Accorging to PELOD Score What is about ? • Disease severity & outcome • Family counselling • Monitoring vital parameters • Management strategy What “ vital parameter” you are anxious from getting worse ? HR RR Bl.Pressure Renal impairment Hepatic impairment Benha Faculty Of Medicine - EGYPT

21. score.png Benha Faculty Of Medicine - EGYPT

22. PELOD Score revealed • Severe critical illness score 30 • Poor outcome Mortality 79.6% • Monitor HR , BL.Pressure , PaO2 s.creat. • Focus on BL.Pressure • Management strategy : Iv fluids Inotropics Antifailure Ventilation Antibiotics Benha Faculty Of Medicine - EGYPT

23. CONCLUSION AND RECOMMENDATIONS Benha Faculty Of Medicine - EGYPT

24. The ICUis an expensive treatment facility where patients of high mortality rates are treated. • Estimation ofdisease severity and probability of death are important elements in determining the prognosis of patients in PICU. • A more accurateprognostic assessmentcan lead to more appropriate monitoring , proper management , and family counseling. • PELOD has recently been validated with good discrimination. Benha Faculty Of Medicine - EGYPT

25. PELOD scoring system is highly reliable and very sensitive to measure severity of illness and determine the probability of death in PICU. • It is valid to be a valuable detector for PICU services and a sensitive director for appropriate monitoring , proper management & family counseling • It gives the priority to focus on vital parameters that affects total score number and the corresponding outcome for patients in PICU. Benha Faculty Of Medicine - EGYPT

26. THANKS FOR ATTENTION