Evaluation of Signs of Inflammation that Can Kill score in predicting mortality in an urban tertiary care centre for children in South India

Authors

  • N. Rajeshwari Department of Pediatrics, Dr. Kamakshi Memorial Hospital, Pallikaranai, Chennai, Tamil Nadu, India
  • Savitha A. Department of Pediatrics, Dr. Kamakshi Memorial Hospital, Pallikaranai, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20202078

Keywords:

Early intervention, Golden hour, Mortality, ROC, SICK score, Triage

Abstract

Background: Mortality in critically ill children is maximum in the first 24 hours. Need of the hour is a rapid clinical scoring system that predicts mortality on admission. This study aims at using the Signs of Inflammation that Can Kill (SICK) score in a tertiary care pediatric hospital in India, to evaluate its usefulness in predicting mortality on admission.

Methods: The study design is a hospital based prospective study for evaluation of diagnostic test for a duration of one year.  The assessment using SICK score was done on arrival prior to initiation of treatment for children admitted through the emergency room and paediatric ward. The variables of SICK score - temperature, heart rate, respiratory rate, systolic BP, oxygen saturation, CRT, sensorium by AVPU scale were measured using standard guidelines.

Results: The study includes a population of 369 children. Children between 1 month to 12 years were included in the study. Out of 369 children studied 24 died. The mortality in the study is 6.5%. The area under the ROC curve is 0.94, which indicates the scores based on regression could predict mortality in 94% subjects correctly. Further a score of 2.5 showed maximum discrimination with a sensitivity of 87.5% and specificity of 87.2%.

Conclusions: The assessment of SICK score in the population will provide objective measure of severity of illness on admission, prediction of mortality, early triage of patients, effective allocation of resources and personnel, enables early intervention, which helps in reducing mortality.

References

Yeh TS, Pollack MM, Ruttimann UE, Holbrook PR, Fields AI. Validation of a Physiologic Stability Index for Use in Critically ill infants and children. Pediatric Res. 1984;18(5):445-51.

Pollack MM, Ruttimann UE, Getson PR. The Pediatric risk of mortality (PRISM) score. Crit Care Med. 1988;16:1110-6.

Pollack MM, Ruttiman UE, Patel KM. PRISM III; An updated Paediatric Risk of Mortality. Crit Care Med. 1996;24(5):743-52.

Terregino CA, Reid JC, Marburger RK, Leipold CG, Ross SE. Secondary emergency department triage (super triage) and trauma team activation: effects on resource utilization and patient care. J Trauma. 1997;43:61-4.

Grove S, Tamburlini G, Molyneux E, Whitesell P, Campbell H. Development and simplified basis of simplified guidelines for emergency triage assessment and treatment in developing countries. Arch Dis Child. 1991;81:473-7.

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 Pub. 2009;94(11):888-93.

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 Postgr Med. 2006;52:102-5.

Sun D, Aikawa N. The natural history of the systemic inflammatory response syndrome and the evaluation of SIRS criteria as a predictor of severity in patients hospitalized through emergency services. Keio J Med. 1999;48:28-37.

Kumar N, Thomas N, Singhal D, Pulliyel JM, Srinivas V. Triage score for severity of illness, Ind Pediatrics. 2003;40:204-10.

Gupta MA, Chakrabarty A, Halstead R, Sahni M, Rangasami J, Puliyel A, et al. Validation of" Signs of Inflammation in Children that Kill"(SICK) score for immediate non-invasive assessment of severity of illness. Italian J Pediatr. 2010 Dec;36(1):35.

Downloads

Published

2020-05-22

Issue

Section

Original Research Articles