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Unnecessary harm is avoided by reliable paediatric index of mortality2 scores without arterial gas sampling

Kalzén, Håkan; Hannegård Hamrin, Tova; Lindberg, Lars LU ; Ingemanson, Ola; Radell, Peter J. and Eksborg, Staffan (2019) In Acta Paediatrica, International Journal of Paediatrics 108(4). p.670-675
Abstract

Aim: To investigate whether unnecessary harm could be avoided in children admitted to paediatric intensive care (PICU), we analysed the impact of arterial blood gas on the paediatric index of mortality score2 (PIM2) and the derived predicted death rate (PDR). Methods: From January 1, 2008 to December 31, 2010, 1793 consecutive admissions, newborn infants to 16 years of age (median 0.71 years) from a single, tertiary PICU in Gothenburg Sweden, were collected. Admission information on arterial oxygen tension (PaO2) and fraction of inspired oxygen (FiO2) was extracted from 990 admissions. Results: There was close agreement between PIM2 score and PDR regardless of whether the PaO2/FiO2 ratio was... (More)

Aim: To investigate whether unnecessary harm could be avoided in children admitted to paediatric intensive care (PICU), we analysed the impact of arterial blood gas on the paediatric index of mortality score2 (PIM2) and the derived predicted death rate (PDR). Methods: From January 1, 2008 to December 31, 2010, 1793 consecutive admissions, newborn infants to 16 years of age (median 0.71 years) from a single, tertiary PICU in Gothenburg Sweden, were collected. Admission information on arterial oxygen tension (PaO2) and fraction of inspired oxygen (FiO2) was extracted from 990 admissions. Results: There was close agreement between PIM2 score and PDR regardless of whether the PaO2/FiO2 ratio was omitted or not. In the subgroup of admissions with a respiratory admission diagnosis, the inclusion of the PaO2/FiO2 ratio increased the accuracy of the PIM2 score as well as the PDR. The standard mortality ratio was slightly but not significantly overestimated by excluding the PaO2/FiO2 ratio. Conclusion: To avoid unnecessary harm to children admitted to PICU, an arterial blood gas analysis should only be performed if clinically indicated or if the child has a respiratory admission diagnosis. Estimation of the PIM2 score and PDR will not be less accurate by this approach.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Arterial blood gas, Paediatric index of mortality2, Paediatric intensive care, Paediatric pain, Predicted death rate
in
Acta Paediatrica, International Journal of Paediatrics
volume
108
issue
4
pages
670 - 675
publisher
Wiley-Blackwell Publishing Ltd
external identifiers
  • scopus:85055026284
ISSN
0803-5253
DOI
10.1111/apa.14580
language
English
LU publication?
yes
id
19e6b91f-3e64-4372-a1e4-4f28dcf08e04
date added to LUP
2018-11-02 09:37:54
date last changed
2019-05-27 18:37:33
@article{19e6b91f-3e64-4372-a1e4-4f28dcf08e04,
  abstract     = {<p>Aim: To investigate whether unnecessary harm could be avoided in children admitted to paediatric intensive care (PICU), we analysed the impact of arterial blood gas on the paediatric index of mortality score2 (PIM2) and the derived predicted death rate (PDR). Methods: From January 1, 2008 to December 31, 2010, 1793 consecutive admissions, newborn infants to 16 years of age (median 0.71 years) from a single, tertiary PICU in Gothenburg Sweden, were collected. Admission information on arterial oxygen tension (PaO<sub>2</sub>) and fraction of inspired oxygen (FiO<sub>2</sub>) was extracted from 990 admissions. Results: There was close agreement between PIM2 score and PDR regardless of whether the PaO<sub>2</sub>/FiO<sub>2</sub> ratio was omitted or not. In the subgroup of admissions with a respiratory admission diagnosis, the inclusion of the PaO<sub>2</sub>/FiO<sub>2</sub> ratio increased the accuracy of the PIM2 score as well as the PDR. The standard mortality ratio was slightly but not significantly overestimated by excluding the PaO<sub>2</sub>/FiO<sub>2</sub> ratio. Conclusion: To avoid unnecessary harm to children admitted to PICU, an arterial blood gas analysis should only be performed if clinically indicated or if the child has a respiratory admission diagnosis. Estimation of the PIM2 score and PDR will not be less accurate by this approach.</p>},
  author       = {Kalzén, Håkan and Hannegård Hamrin, Tova and Lindberg, Lars and Ingemanson, Ola and Radell, Peter J. and Eksborg, Staffan},
  issn         = {0803-5253},
  keyword      = {Arterial blood gas,Paediatric index of mortality2,Paediatric intensive care,Paediatric pain,Predicted death rate},
  language     = {eng},
  number       = {4},
  pages        = {670--675},
  publisher    = {Wiley-Blackwell Publishing Ltd},
  series       = {Acta Paediatrica, International Journal of Paediatrics},
  title        = {Unnecessary harm is avoided by reliable paediatric index of mortality2 scores without arterial gas sampling},
  url          = {http://dx.doi.org/10.1111/apa.14580},
  volume       = {108},
  year         = {2019},
}