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Global PARITY: study design for a multi-centered, international point prevalence study to estimate the burden of pediatric acute critical illness in resource-limited settings / Eliana López Barón    

Público ISBD Título : Global PARITY: study design for a multi-centered, international point prevalence study to estimate the burden of pediatric acute critical illness in resource-limited settings Tipo de documento : documento electrónico Autores : Eliana López Barón, Fecha de publicación : 2022 Títulos uniformes : Frontiers in Pediatrics Idioma : Inglés (eng) Palabras clave : pediatric critical illness  acute pediatric care  critical care  outcome  low-and lower-middle-income countries  resource utilization  low resource setting Resumen : Background: The burden of pediatric critical illness and resource utilization by children with critical illness in resource limited settings (RLS) are largely unknown. Without specific data that captures key aspects of critical illness, disease presentation, and resource utilization for pediatric populations in RLS, development of a contextual framework for appropriate, evidence-based interventions to guide allocation of limited but available resources is challenging. We present this methods paper which describes our efforts to determine the prevalence, etiology, hospital outcomes, and resource utilization associated with pediatric acute, critical illness in RLS globally. Methods: We will conduct a prospective, observational, multicenter, multinational point prevalence study in sixty-one participating RLS hospitals from North, Central and South America, Africa, Middle East and South Asia with four sampling time points over a 12-month period. Children aged 29 days to 14 years evaluated for acute illness or injury in an emergency department) or directly admitted to an inpatient unit will be enrolled and followed for hospital outcomes and resource utilization for the first seven days of hospitalization. The primary outcome will be prevalence of acute critical illness, which Global PARITY has defined as death within 48 hours of presentation to the hospital, including ED mortality; or admission/transfer to an HDU or ICU; or transfer to another institution for a higher level-of-care; or receiving critical care-level interventions (vasopressor infusion, invasive mechanical ventilation, non-invasive mechanical ventilation) regardless of location in the hospital, among children presenting to the hospital. Secondary outcomes include etiology of critical illness, in-hospital mortality, cause of death, resource utilization, length of hospital stay, and change in neurocognitive status. Data will be managed via REDCap, aggregated, and analyzed across sites. Discussion: This study is expected to address the current gap in understanding of the burden, etiology, resource utilization and outcomes associated with pediatric acute and critical illness in RLS. These data are crucial to inform future research and clinical management decisions and to improve global pediatric hospital outcomes. Mención de responsabilidad : Qalab Abbas, Adrian Holloway, Paula Caporal, Eliana López-Barón, Asya Agulnik, Kenneth E. Remy, John A. Appiah, Jonah Attebery, Ericka L. Fink, Jan Hau Lee, Shubhada Hooli, Niranjan Kissoon, Erika Mille, Srinivas Murthy, Fiona Muttalib, Katie Nielsen, Maria Puerto-Torres, Karla Rodrigues, Firas Sakaan, Adriana Teixeira Rodrigues, Erica A. Tabor, Amelie von Saint Andre-von Arnim, Matthew O. Wiens, William Blackwelder, David He, Teresa B. Kortz and Adnan T. Bhutta on behalf of the PALISI Global Health Subgroup the Global PARITY Investigators Referencia : Front Pediatr. 2022 Jan 28;9:793326. DOI (Digital Object Identifier) : 10.3389/fped.2021.793326 PMID : 35155314 Derechos de uso : CC BY En línea : https://www.frontiersin.org/articles/10.3389/fped.2021.793326/full Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=6008 Global PARITY: study design for a multi-centered, international point prevalence study to estimate the burden of pediatric acute critical illness in resource-limited settings [documento electrónico] / Eliana López Barón,  . - 2022. Obra : Frontiers in Pediatrics Idioma : Inglés (eng) Palabras clave : pediatric critical illness  acute pediatric care  critical care  outcome  low-and lower-middle-income countries  resource utilization  low resource setting Resumen : Background: The burden of pediatric critical illness and resource utilization by children with critical illness in resource limited settings (RLS) are largely unknown. Without specific data that captures key aspects of critical illness, disease presentation, and resource utilization for pediatric populations in RLS, development of a contextual framework for appropriate, evidence-based interventions to guide allocation of limited but available resources is challenging. We present this methods paper which describes our efforts to determine the prevalence, etiology, hospital outcomes, and resource utilization associated with pediatric acute, critical illness in RLS globally. Methods: We will conduct a prospective, observational, multicenter, multinational point prevalence study in sixty-one participating RLS hospitals from North, Central and South America, Africa, Middle East and South Asia with four sampling time points over a 12-month period. Children aged 29 days to 14 years evaluated for acute illness or injury in an emergency department) or directly admitted to an inpatient unit will be enrolled and followed for hospital outcomes and resource utilization for the first seven days of hospitalization. The primary outcome will be prevalence of acute critical illness, which Global PARITY has defined as death within 48 hours of presentation to the hospital, including ED mortality; or admission/transfer to an HDU or ICU; or transfer to another institution for a higher level-of-care; or receiving critical care-level interventions (vasopressor infusion, invasive mechanical ventilation, non-invasive mechanical ventilation) regardless of location in the hospital, among children presenting to the hospital. Secondary outcomes include etiology of critical illness, in-hospital mortality, cause of death, resource utilization, length of hospital stay, and change in neurocognitive status. Data will be managed via REDCap, aggregated, and analyzed across sites. Discussion: This study is expected to address the current gap in understanding of the burden, etiology, resource utilization and outcomes associated with pediatric acute and critical illness in RLS. These data are crucial to inform future research and clinical management decisions and to improve global pediatric hospital outcomes. Mención de responsabilidad : Qalab Abbas, Adrian Holloway, Paula Caporal, Eliana López-Barón, Asya Agulnik, Kenneth E. Remy, John A. Appiah, Jonah Attebery, Ericka L. Fink, Jan Hau Lee, Shubhada Hooli, Niranjan Kissoon, Erika Mille, Srinivas Murthy, Fiona Muttalib, Katie Nielsen, Maria Puerto-Torres, Karla Rodrigues, Firas Sakaan, Adriana Teixeira Rodrigues, Erica A. Tabor, Amelie von Saint Andre-von Arnim, Matthew O. Wiens, William Blackwelder, David He, Teresa B. Kortz and Adnan T. Bhutta on behalf of the PALISI Global Health Subgroup the Global PARITY Investigators Referencia : Front Pediatr. 2022 Jan 28;9:793326. DOI (Digital Object Identifier) : 10.3389/fped.2021.793326 PMID : 35155314 Derechos de uso : CC BY En línea : https://www.frontiersin.org/articles/10.3389/fped.2021.793326/full Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=6008

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Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study / Byron Enrique Piñeres Olave  

Público ISBD Título : Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study Tipo de documento : documento electrónico Autores : Byron Enrique Piñeres Olave, Fecha de publicación : 2020 Títulos uniformes : Intensive Care Medicine Idioma : Inglés (eng) Palabras clave : ARDS  Chest radiograph  Diagnostic accuracy  Inter-rater variability  Outcome Resumen : Purpose: Definitions of acute respiratory distress syndrome (ARDS) include radiographic criteria, but there are concerns about reliability and prognostic relevance. This study aimed to evaluate the independent relationship between chest imaging and mortality and examine the inter-rater variability of interpretations of chest radiographs (CXR) in pediatric ARDS (PARDS). Methods: Prospective, international observational study in children meeting Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria for PARDS, which requires new infiltrate(s) consistent with pulmonary parenchymal disease, without mandating bilateral infiltrates. Mortality analysis focused on the entire cohort, whereas inter-observer variability used a subset of patients with blinded, simultaneous interpretation of CXRs by intensivists and radiologists. Results: Bilateral infiltrates and four quadrants of alveolar consolidation were associated with mortality on a univariable basis, using CXRs from 708 patients with PARDS. For patients on either invasive (IMV) or non-invasive ventilation (NIV) with PaO2/FiO2 (PF) ratios (or SpO2/FiO2 (SF) ratio equivalent) > 100, neither bilateral infiltrates (OR 1.3 (95% CI 0.68, 2.5), p = 0.43), nor 4 quadrants of alveolar consolidation (OR 1.6 (0.85, 3), p = 0.14) were associated with mortality. For patients with PF ≤ 100, bilateral infiltrates (OR 3.6 (1.4, 9.4), p = 0.01) and four quadrants of consolidation (OR 2.0 (1.14, 3.5), p = 0.02) were associated with higher mortality. A subset of 702 CXRs from 233 patients had simultaneous interpretations. Interobserver agreement for bilateral infiltrates and quadrants was “slight” (kappa 0.31 and 0.33). Subgroup analysis showed agreement did not differ when stratified by PARDS severity but was slightly higher for children with chronic respiratory support (kappa 0.62), NIV at PARDS diagnosis (kappa 0.53), age > 10 years (kappa 0.43) and fluid balance > 40 ml/kg (kappa 0.48). Conclusion: Bilateral infiltrates and quadrants of alveolar consolidation are associated with mortality only for those with PF ratio ≤ 100, although there is high- inter-rater variability in these chest-x ray parameters. Mención de responsabilidad : Yolanda M López-Fernández, Lincoln S Smith, Joseph G Kohne, Jason P Weinman, Vicent Modesto-Alapont, Susana B Reyes-Dominguez, Alberto Medina, Byron E Piñeres-Olave, Natalie Mahieu, Margaret J Klein, Heidi R Flori, Philippe Jouvet, Robinder G Khemani, the Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) V3 Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Referencia : Intensive Care Med. 2020 Jul;46(7):1382-1393. DOI (Digital Object Identifier) : 10.1007/s00134-020-06074-7 PMID : 32451578 En línea : https://link.springer.com/article/10.1007/s00134-020-06074-7 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5099 Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study [documento electrónico] / Byron Enrique Piñeres Olave,  . - 2020. Obra : Intensive Care Medicine Idioma : Inglés (eng) Palabras clave : ARDS  Chest radiograph  Diagnostic accuracy  Inter-rater variability  Outcome Resumen : Purpose: Definitions of acute respiratory distress syndrome (ARDS) include radiographic criteria, but there are concerns about reliability and prognostic relevance. This study aimed to evaluate the independent relationship between chest imaging and mortality and examine the inter-rater variability of interpretations of chest radiographs (CXR) in pediatric ARDS (PARDS). Methods: Prospective, international observational study in children meeting Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria for PARDS, which requires new infiltrate(s) consistent with pulmonary parenchymal disease, without mandating bilateral infiltrates. Mortality analysis focused on the entire cohort, whereas inter-observer variability used a subset of patients with blinded, simultaneous interpretation of CXRs by intensivists and radiologists. Results: Bilateral infiltrates and four quadrants of alveolar consolidation were associated with mortality on a univariable basis, using CXRs from 708 patients with PARDS. For patients on either invasive (IMV) or non-invasive ventilation (NIV) with PaO2/FiO2 (PF) ratios (or SpO2/FiO2 (SF) ratio equivalent) > 100, neither bilateral infiltrates (OR 1.3 (95% CI 0.68, 2.5), p = 0.43), nor 4 quadrants of alveolar consolidation (OR 1.6 (0.85, 3), p = 0.14) were associated with mortality. For patients with PF ≤ 100, bilateral infiltrates (OR 3.6 (1.4, 9.4), p = 0.01) and four quadrants of consolidation (OR 2.0 (1.14, 3.5), p = 0.02) were associated with higher mortality. A subset of 702 CXRs from 233 patients had simultaneous interpretations. Interobserver agreement for bilateral infiltrates and quadrants was “slight” (kappa 0.31 and 0.33). Subgroup analysis showed agreement did not differ when stratified by PARDS severity but was slightly higher for children with chronic respiratory support (kappa 0.62), NIV at PARDS diagnosis (kappa 0.53), age > 10 years (kappa 0.43) and fluid balance > 40 ml/kg (kappa 0.48). Conclusion: Bilateral infiltrates and quadrants of alveolar consolidation are associated with mortality only for those with PF ratio ≤ 100, although there is high- inter-rater variability in these chest-x ray parameters. Mención de responsabilidad : Yolanda M López-Fernández, Lincoln S Smith, Joseph G Kohne, Jason P Weinman, Vicent Modesto-Alapont, Susana B Reyes-Dominguez, Alberto Medina, Byron E Piñeres-Olave, Natalie Mahieu, Margaret J Klein, Heidi R Flori, Philippe Jouvet, Robinder G Khemani, the Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) V3 Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Referencia : Intensive Care Med. 2020 Jul;46(7):1382-1393. DOI (Digital Object Identifier) : 10.1007/s00134-020-06074-7 PMID : 32451578 En línea : https://link.springer.com/article/10.1007/s00134-020-06074-7 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5099

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Validation of the Status epilepticus severity score (STESS) at high-complexity hospitals in Medellín, Colombia / Lady Diana Ladino Malagón  

Público ISBD Título : Validation of the Status epilepticus severity score (STESS) at high-complexity hospitals in Medellín, Colombia Tipo de documento : documento electrónico Autores : Lady Diana Ladino Malagón, Fecha de publicación : 2020 Títulos uniformes : Seizure Idioma : Inglés (eng) Palabras clave : Complication  Epilepsy  Death  Outcome  Prognosis  Score Resumen : Purpose: The Status Epilepticus Severity Score (STESS) is one of the most well-known clinical scoring systems to predict mortality in status epilepticus (SE). The objective of this study was to validate STESS in a Colombian population. Method: We evaluated historical data of adult patients (age ≥16 years) with a clinical or electroencephalographic diagnosis of SE admitted between 2014 and 2017. Prospectively, we included patients admitted from January to June of 2018. The primary outcome was in-hospital mortality. Receiver operating characteristic (ROC)-analysis, determination of best cutoff values, sensitivity, specificity, and positive and negative likelihood ratios were performed. Results: The sample was 395 patients, with in-hospital mortality of 16.8 %. The area under the ROC curve for STESS was 0.84. A cutoff point of ≥3 produced the highest sensitivity of 84.9 % (95 % CI 73.9 %-92.5 %) and a specificity of 65.7 % (95 % CI 60.2 %–70.8 %), with a positive likelihood ratio of 2.5 and a negative likelihood ratio of 0.2. Conclusions: STESS is a useful tool to predict mortality in patients with SE. In Medellin, Colombia, a STESS  Mención de responsabilidad : Juan Pablo Millán Sandoval, Luisa María Escobar del Rio, Edison Augusto Gómez, Lady Diana Ladino, Lina María López Ospina, Diana Marcela Díaz, José Fernando Zapata, Olga Helena Hernández Referencia : Seizure. 2020 Oct;81:287-291. DOI (Digital Object Identifier) : 10.1016/j.seizure.2020.08.020 PMID : 32927243 En línea : https://linkinghub.elsevier.com/retrieve/pii/S1059131120302570 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5139 Validation of the Status epilepticus severity score (STESS) at high-complexity hospitals in Medellín, Colombia [documento electrónico] / Lady Diana Ladino Malagón,  . - 2020. Obra : Seizure Idioma : Inglés (eng) Palabras clave : Complication  Epilepsy  Death  Outcome  Prognosis  Score Resumen : Purpose: The Status Epilepticus Severity Score (STESS) is one of the most well-known clinical scoring systems to predict mortality in status epilepticus (SE). The objective of this study was to validate STESS in a Colombian population. Method: We evaluated historical data of adult patients (age ≥16 years) with a clinical or electroencephalographic diagnosis of SE admitted between 2014 and 2017. Prospectively, we included patients admitted from January to June of 2018. The primary outcome was in-hospital mortality. Receiver operating characteristic (ROC)-analysis, determination of best cutoff values, sensitivity, specificity, and positive and negative likelihood ratios were performed. Results: The sample was 395 patients, with in-hospital mortality of 16.8 %. The area under the ROC curve for STESS was 0.84. A cutoff point of ≥3 produced the highest sensitivity of 84.9 % (95 % CI 73.9 %-92.5 %) and a specificity of 65.7 % (95 % CI 60.2 %–70.8 %), with a positive likelihood ratio of 2.5 and a negative likelihood ratio of 0.2. Conclusions: STESS is a useful tool to predict mortality in patients with SE. In Medellin, Colombia, a STESS  Mención de responsabilidad : Juan Pablo Millán Sandoval, Luisa María Escobar del Rio, Edison Augusto Gómez, Lady Diana Ladino, Lina María López Ospina, Diana Marcela Díaz, José Fernando Zapata, Olga Helena Hernández Referencia : Seizure. 2020 Oct;81:287-291. DOI (Digital Object Identifier) : 10.1016/j.seizure.2020.08.020 PMID : 32927243 En línea : https://linkinghub.elsevier.com/retrieve/pii/S1059131120302570 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5139

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The potential impact of admission insulin levels on patient outcome in the intensive care unit / Gisela de la Rosa Echavez ; Esdras Martín Vásquez Mejía ; Jorge Hernando Donado Gómez ; Marisol Bedoya Arias ; Álvaro Humberto Restrepo Cuartas ; Gustavo Roncancio ; Carlos Alberto Cadavid Gutiérrez ; Fabián Alberto Jaimes Barragán  

Público ISBD Título : The potential impact of admission insulin levels on patient outcome in the intensive care unit Tipo de documento : documento electrónico Autores : Gisela de la Rosa Echavez, ; Esdras Martín Vásquez Mejía, ; Jorge Hernando Donado Gómez, ; Marisol Bedoya Arias, ; Álvaro Humberto Restrepo Cuartas, ; Gustavo Roncancio, ; Carlos Alberto Cadavid Gutiérrez, ; Fabián Alberto Jaimes Barragán, Fecha de publicación : 2013 Títulos uniformes : Journal of Trauma and Acute Care Surgery Idioma : Inglés (eng) Palabras clave : Insulin  insulin resistance  critical care  critical illness  outcome Resumen : Background: Blood levels of insulin in patients with critical illness at admission to the intensive care unit (ICU) and its association with in hospital mortality are not fully defined. Our objective was to determine this association in a cohort of patients with critical illness who attended in a mixed ICU. Methods: Prospective cohort was nested in a randomized clinical trial conducted in a 12-bed mixed ICU in a tertiary hospital in Medellin (Colombia). One hundred sixty consecutively admitted patients, 15 years or older, were analyzed. Blood insulin and blood glucose levels were measured at admission to the ICU, as well as Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores. A logistic regression model was created with in-hospital mortality as the outcome. Results: In-hospital mortality was 57 (35.6%) of 160. Survivors had lower Acute Physiology and Chronic Health Evaluation II (median, 13 vs. 17) and lower insulin levels (median, 6.5 vs. 9 µU/mL) than did nonsurvivors. More women than men died (27 [48.2%] of 56 vs. 30 [28.8%] of 104), and 39% of the deaths (n = 22) occurred in patients with sepsis. Patients with insulin levels greater than 15 µU/mL had a higher mortality rate compared with patients with values of 5 µU/mL to 15 µU/mL (odds ratio, 3.57; 95% confidence interval, 1.18–10.8). Conclusion: At admission to the ICU, patients with critical illness showed hyperglycemia and relatively decreased insulin levels. High levels of insulin were independently associated with in-hospital mortality in this study population. Mención de responsabilidad : Gisela De La Rosa, Esdras Martin Vasquez, Alvaro Mauricio Quintero, Jorge Hernando Donado, Marisol Bedoya, Alvaro Humberto Restrepo, Gustavo Roncancio, Carlos Alberto Cadavid, Fabian Alberto Jaimes, Grupo de Investigacion en Cuidado Intensivo GICI-HPTU Referencia : J Trauma Acute Care Surg. 2013 Jan;74(1):270-5. DOI (Digital Object Identifier) : 10.1097/TA.0b013e3182788042 PMID : 23271103 En línea : https://journals.lww.com/jtrauma/Abstract/2013/01000/The_potential_impact_of_adm [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3660 The potential impact of admission insulin levels on patient outcome in the intensive care unit [documento electrónico] / Gisela de la Rosa Echavez, ; Esdras Martín Vásquez Mejía, ; Jorge Hernando Donado Gómez, ; Marisol Bedoya Arias, ; Álvaro Humberto Restrepo Cuartas, ; Gustavo Roncancio, ; Carlos Alberto Cadavid Gutiérrez, ; Fabián Alberto Jaimes Barragán,  . - 2013. Obra : Journal of Trauma and Acute Care Surgery Idioma : Inglés (eng) Palabras clave : Insulin  insulin resistance  critical care  critical illness  outcome Resumen : Background: Blood levels of insulin in patients with critical illness at admission to the intensive care unit (ICU) and its association with in hospital mortality are not fully defined. Our objective was to determine this association in a cohort of patients with critical illness who attended in a mixed ICU. Methods: Prospective cohort was nested in a randomized clinical trial conducted in a 12-bed mixed ICU in a tertiary hospital in Medellin (Colombia). One hundred sixty consecutively admitted patients, 15 years or older, were analyzed. Blood insulin and blood glucose levels were measured at admission to the ICU, as well as Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores. A logistic regression model was created with in-hospital mortality as the outcome. Results: In-hospital mortality was 57 (35.6%) of 160. Survivors had lower Acute Physiology and Chronic Health Evaluation II (median, 13 vs. 17) and lower insulin levels (median, 6.5 vs. 9 µU/mL) than did nonsurvivors. More women than men died (27 [48.2%] of 56 vs. 30 [28.8%] of 104), and 39% of the deaths (n = 22) occurred in patients with sepsis. Patients with insulin levels greater than 15 µU/mL had a higher mortality rate compared with patients with values of 5 µU/mL to 15 µU/mL (odds ratio, 3.57; 95% confidence interval, 1.18–10.8). Conclusion: At admission to the ICU, patients with critical illness showed hyperglycemia and relatively decreased insulin levels. High levels of insulin were independently associated with in-hospital mortality in this study population. Mención de responsabilidad : Gisela De La Rosa, Esdras Martin Vasquez, Alvaro Mauricio Quintero, Jorge Hernando Donado, Marisol Bedoya, Alvaro Humberto Restrepo, Gustavo Roncancio, Carlos Alberto Cadavid, Fabian Alberto Jaimes, Grupo de Investigacion en Cuidado Intensivo GICI-HPTU Referencia : J Trauma Acute Care Surg. 2013 Jan;74(1):270-5. DOI (Digital Object Identifier) : 10.1097/TA.0b013e3182788042 PMID : 23271103 En línea : https://journals.lww.com/jtrauma/Abstract/2013/01000/The_potential_impact_of_adm [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3660

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