Gupta et al reported a model for predicting a favorable neurologic outcome for a pediatric patient in the PICU. The authors are from the University of Arkansas, Virtual Pediatric Systems, Medical College of Wisconsin and USC Keck School of Medicine.
Patient selection: age < 18 years old admitted to PICU
Outcome: Pediatric Cerebral Performance Category Scale, with unfavorable if PCPC decreased >= 1 between ICU admission and discharge
Parameters:
(1) age in months
(2) weight in kilograms
(3) race or ethnic group
(4) chromosomal anomaly
(5) PIM-2 score at ICU admission
(6) acute respiratory failure
(7) shock or hypotension
(8) cardiac arrest
(9) renal insufficiency
(10) stroke (brain hemorrhage or ischemia)
(11) seizures
(12) head trauma
(13) non-head trauma
(14) acquired heart disease
(15) cardiac surgery
(16) ECMO
(17) nitric oxide
(18) high-frequency oscillatory ventilation (HFOV)
(19) conventional ventilation
(20) ICU length of stay in days
(21) mechanical ventilation duration in days
|
Parameter |
Finding |
Points |
|
age in months |
|
-0.001215 * (months) |
|
weight in kilograms |
|
-0.00724 * (weight) |
|
race |
white |
0 |
|
|
African American |
-0.0874 |
|
|
Hispanic |
-0.082 |
|
|
other |
-0.1525 |
|
chromosomal anomaly |
no |
0 |
|
|
yes |
1.0761 |
|
PIM-2 score |
|
-0.4007 * (PIM2) |
|
acute respiratory failure |
no |
0 |
|
|
yes |
-0.1078 |
|
shock or hypotension |
no |
0 |
|
|
yes |
-0.144 |
|
cardiac arrest |
no |
0 |
|
|
yes |
-0.6893 |
|
renal insufficiency |
no |
0 |
|
|
yes |
-0.2008 |
|
stroke |
no |
0 |
|
|
yes |
-1.6533 |
|
seizures |
no |
0 |
|
|
yes |
-0.0607 |
|
head trauma |
no |
0 |
|
|
yes |
-1.5684 |
|
non-head trauma |
no |
0 |
|
|
yes |
-0.6085 |
|
acquired heart disease |
no |
0 |
|
|
yes |
0.3178 |
|
cardiac surgery |
no |
0 |
|
|
yes |
1.0414 |
|
ECMO |
no |
0 |
|
|
yes |
-0.3164 |
|
nitric oxide |
no |
0 |
|
|
yes |
0.4043 |
|
HFOV |
no |
0 |
|
|
yes |
-1.1584 |
|
conventional ventilation |
no |
0 |
|
|
yes |
-1.4794 |
|
ICU LOS |
|
-0.01428 * (days) |
|
mechanical ventilation |
|
-0.03094 * (days) |
value of X =
= SUM(points for all of the parameters) + 4.9568
probability of favorable neurologic outcome =
= 1 / (1 + EXP((-1) * X)
Performance:
• The area under the ROC curve was 0.90 for the validation cohort.
