Calibration of pediatric risk of admission score (prisa) in zagazig university picu as a measure of mortality

To assess the risk factors for admission contributing to mortality in Zagazig Pediatric Intensive Care Unit and to develop and validate a pediatric emergency severity of illness assessment scoring method using hospital admission as the primary outcome indicator.Methods. This prospective cohort study included 260 patients of consecutive admissions to Zagazig University Children’s Hospital at its pediatric intensive care unit (PICU) from 1 August 2010 to end of December 2010. Patient aged from 2nd month till 14 years old either male or female referred from any residency diagnosed as an emergency case referred wither from doctor of another hospital stayed more than 24 hour in PICU were included in our study. All cases were subjected to taking a written consent from parents, full history taking, and complete clinical examination including mental status, vital signs, general examination & regional examination. Laboratory investigation in the form of RBS, CBC, LFT, RFT, ABG, and Electrolytes were collected and noted for each case. Primary emergency department diagnosis was included. Emergency department interventions including neubilization, isotonic fluid boluses, parenteral antibiotic, mechanical ventilation and others were included and categorized among different diagnosis groups. Lastly we fill in PRISA score sheet for each patient.Results.Over all the six months the study period there were 260 consecutive admissions to PICU, 60 patients were excluded from the study (less than 24 hours admissions) and 200 patients were included with outcome of 104 survivors and 96 non-survivors. Mortality rate was (48%).Most patients in our PICU were referred from doctor being mostly survivor later but most cases of non-survivors were referred from other hospital arrived mostly by ambulance. Most patients were comatosed at presentation with 44% non-survivors and 56% survivors. About 19% of patients at presentation were alert most of them are survivors later on.There was a great significant of recording respiratory rate to predict the outcome of cases. Neutrophil counts of non- survivors were more indicating high incidence of infection at admission. Recording random blood sugar was a good indicator for mortality besides recording of creatinine level. Coagulation profile among studied group showed significant difference between both groups.We also collect data about therapy and we found the importance of using dopamine, double antibiotics, diuretics, plasma transfusion, airway suction and mechanical ventilation as a major leading causes of mortality among non-survivors.Conclusions.Application of a scoring system for patient is a must as routine work to improve service quality. The great importance of daily file recording and side sheets for patients in ICU. The importance of good equipped with trained team transport method to reduce risk of mortality among critically ill children. Consciousness level assessment and follow up during stay in ICU is a good predictive mortality index. Vital signs are vital to all patients. So regular recording for each patient is very important.