Reducing Childhood Admissions to the PICU for Poisoning (ReCAP2) by Predicting Unnecessary PICU Admissions After Acute Intoxication
| Autor: | Jocelyn R. Grunwell, Ezaldeen A. Numur, Pradip Kamat, Robert J. Geller, Curtis Travers, Meral M. Patel, Jana A. Stockwell |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Georgia Poison Control Centers Adolescent Databases Factual Population Psychological intervention Poison control Intensive Care Units Pediatric Critical Care and Intensive Care Medicine Suicide prevention Article Occupational safety and health Decision Support Techniques 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Injury prevention Humans Medicine Hospital Mortality 030212 general & internal medicine Child education Retrospective Studies education.field_of_study Receiver operating characteristic business.industry Poisoning Infant Retrospective cohort study Hospitalization ROC Curve Child Preschool Pediatrics Perinatology and Child Health Emergency medicine Female business |
| Zdroj: | Pediatric Critical Care Medicine. 19:e120-e129 |
| ISSN: | 1529-7535 |
| DOI: | 10.1097/pcc.0000000000001410 |
| Popis: | OBJECTIVE To derive and validate clinical prediction models to identify children at low risk of clinically significant intoxications for whom intensive care admission is unnecessary. DESIGN Retrospective review of data in the National Poison Data Systems from 2011 to 2014 and Georgia Poison Center cases from July to December 2016. SETTING United States PICUs and poison centers participating in the American Association of Poison Control Centers from 2011 to 2016. PATIENTS Children 18 years and younger admitted to a United States PICU following an acute intoxication. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary study outcome was the occurrence of clinically significant intoxications defined a priori as organ system-based clinical effects that require intensive care monitoring and interventions. We analyzed 70,364 cases. Derivation (n = 42,240; 60%) and validation cohorts (n = 28,124; 40%) were randomly selected from the eligible population and had similar distributions of clinical effects and PICU interventions. PICU interventions were performed in 1,835 children (14.1%) younger than 6 years, in 374 children (15.4%) 6-12 years, and in 4,446 children (16.5%) 13 years and older. We developed highly predictive models with an area under the receiver operating characteristic curve of 0.834 (< 6 yr), 0.771 (6-12 yr), and 0.786 (≥13 yr), respectively. For predicted probabilities of less than or equal to 0.10 in the validation cohorts, the negative predictive values were 95.4% (< 6 yr), 94.9% (6-12 yr), and 95.1% (≥ 13 yr). An additional 700 patients from the Georgia Poison Center were used to validate the model and would have reduced PICU admission by 31.4% (n = 110). CONCLUSIONS These validated models identified children at very low risk of clinically significant intoxications for whom pediatric intensive care admission can be avoided. Application of this model using Georgia Poison Center data could have resulted in a 30% reduction in PICU admissions following intoxication. |
| Databáze: | OpenAIRE |
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