Cargando…

The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department

BACKGROUND: Respiratory distress is a common presenting complaint in children brought to the Emergency Department (ED). The Clinical Respiratory Score (CRS) has shown promise as a screen for severe illness in High Income Countries. We aimed to validate the admission CRS in children presenting to the...

Descripción completa

Detalles Bibliográficos
Autores principales: Nayani, Kanwal, Naeem, Rubaba, Munir, Owais, Naseer, Naureen, Feroze, Asher, Brown, Nick, Mian, Asad I.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208017/
https://www.ncbi.nlm.nih.gov/pubmed/30376827
http://dx.doi.org/10.1186/s12887-018-1317-2
_version_ 1783366632469430272
author Nayani, Kanwal
Naeem, Rubaba
Munir, Owais
Naseer, Naureen
Feroze, Asher
Brown, Nick
Mian, Asad I.
author_facet Nayani, Kanwal
Naeem, Rubaba
Munir, Owais
Naseer, Naureen
Feroze, Asher
Brown, Nick
Mian, Asad I.
author_sort Nayani, Kanwal
collection PubMed
description BACKGROUND: Respiratory distress is a common presenting complaint in children brought to the Emergency Department (ED). The Clinical Respiratory Score (CRS) has shown promise as a screen for severe illness in High Income Countries. We aimed to validate the admission CRS in children presenting to the ED of a Low-to Middle Income Country. METHODS: Children (1 month to 16 years) presenting with respiratory distress to the ED of the Aga Khan University Hospital, Karachi, Pakistan, between November 2015 to March 2016, were enrolled. The CRS was measured at initial presentation, prior to any management and 2 h after treatment was started. The predictive value for admission to the paediatric critical care units for a variety of cut offs for CRS at presentation were derived. RESULTS: A total of 112 children (70% male) of median age 12 months (IQR 2, 34.5 months) were enrolled. Patients with severe CRS (score 8–12) at presentation were more likely to be admitted to paediatric critical care (90% vs. 23% with mild-moderate CRS; OR: 5.7; 95% CI: 2.2–15.3, p < 0.001). The sensitivity and specificity of CRS > 3 in predicting outcome were 94% (95% CI 79.8–99.3) and 40% (95% CI 35–45), respectively, with a positive likelihood ratio of 1.6 (95% CI 1.31–1.98) and negative predictive value of 94% (95% CI 81–98). CONCLUSION: An admission CRS of > 3 in the ED of a Low-to Middle Income Country had excellent predictive value for disease severity, and it should be considered for incorporation into ED triage protocols.
format Online
Article
Text
id pubmed-6208017
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-62080172018-11-16 The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department Nayani, Kanwal Naeem, Rubaba Munir, Owais Naseer, Naureen Feroze, Asher Brown, Nick Mian, Asad I. BMC Pediatr Research Article BACKGROUND: Respiratory distress is a common presenting complaint in children brought to the Emergency Department (ED). The Clinical Respiratory Score (CRS) has shown promise as a screen for severe illness in High Income Countries. We aimed to validate the admission CRS in children presenting to the ED of a Low-to Middle Income Country. METHODS: Children (1 month to 16 years) presenting with respiratory distress to the ED of the Aga Khan University Hospital, Karachi, Pakistan, between November 2015 to March 2016, were enrolled. The CRS was measured at initial presentation, prior to any management and 2 h after treatment was started. The predictive value for admission to the paediatric critical care units for a variety of cut offs for CRS at presentation were derived. RESULTS: A total of 112 children (70% male) of median age 12 months (IQR 2, 34.5 months) were enrolled. Patients with severe CRS (score 8–12) at presentation were more likely to be admitted to paediatric critical care (90% vs. 23% with mild-moderate CRS; OR: 5.7; 95% CI: 2.2–15.3, p < 0.001). The sensitivity and specificity of CRS > 3 in predicting outcome were 94% (95% CI 79.8–99.3) and 40% (95% CI 35–45), respectively, with a positive likelihood ratio of 1.6 (95% CI 1.31–1.98) and negative predictive value of 94% (95% CI 81–98). CONCLUSION: An admission CRS of > 3 in the ED of a Low-to Middle Income Country had excellent predictive value for disease severity, and it should be considered for incorporation into ED triage protocols. BioMed Central 2018-10-30 /pmc/articles/PMC6208017/ /pubmed/30376827 http://dx.doi.org/10.1186/s12887-018-1317-2 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Nayani, Kanwal
Naeem, Rubaba
Munir, Owais
Naseer, Naureen
Feroze, Asher
Brown, Nick
Mian, Asad I.
The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department
title The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department
title_full The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department
title_fullStr The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department
title_full_unstemmed The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department
title_short The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department
title_sort clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208017/
https://www.ncbi.nlm.nih.gov/pubmed/30376827
http://dx.doi.org/10.1186/s12887-018-1317-2
work_keys_str_mv AT nayanikanwal theclinicalrespiratoryscorepredictspaediatriccriticalcaredispositioninchildrenwithrespiratorydistresspresentingtotheemergencydepartment
AT naeemrubaba theclinicalrespiratoryscorepredictspaediatriccriticalcaredispositioninchildrenwithrespiratorydistresspresentingtotheemergencydepartment
AT munirowais theclinicalrespiratoryscorepredictspaediatriccriticalcaredispositioninchildrenwithrespiratorydistresspresentingtotheemergencydepartment
AT naseernaureen theclinicalrespiratoryscorepredictspaediatriccriticalcaredispositioninchildrenwithrespiratorydistresspresentingtotheemergencydepartment
AT ferozeasher theclinicalrespiratoryscorepredictspaediatriccriticalcaredispositioninchildrenwithrespiratorydistresspresentingtotheemergencydepartment
AT brownnick theclinicalrespiratoryscorepredictspaediatriccriticalcaredispositioninchildrenwithrespiratorydistresspresentingtotheemergencydepartment
AT mianasadi theclinicalrespiratoryscorepredictspaediatriccriticalcaredispositioninchildrenwithrespiratorydistresspresentingtotheemergencydepartment
AT nayanikanwal clinicalrespiratoryscorepredictspaediatriccriticalcaredispositioninchildrenwithrespiratorydistresspresentingtotheemergencydepartment
AT naeemrubaba clinicalrespiratoryscorepredictspaediatriccriticalcaredispositioninchildrenwithrespiratorydistresspresentingtotheemergencydepartment
AT munirowais clinicalrespiratoryscorepredictspaediatriccriticalcaredispositioninchildrenwithrespiratorydistresspresentingtotheemergencydepartment
AT naseernaureen clinicalrespiratoryscorepredictspaediatriccriticalcaredispositioninchildrenwithrespiratorydistresspresentingtotheemergencydepartment
AT ferozeasher clinicalrespiratoryscorepredictspaediatriccriticalcaredispositioninchildrenwithrespiratorydistresspresentingtotheemergencydepartment
AT brownnick clinicalrespiratoryscorepredictspaediatriccriticalcaredispositioninchildrenwithrespiratorydistresspresentingtotheemergencydepartment
AT mianasadi clinicalrespiratoryscorepredictspaediatriccriticalcaredispositioninchildrenwithrespiratorydistresspresentingtotheemergencydepartment