Brogan et al reported the Pediatric Glucocorticoid Toxicity Index (pGTI). This is based on the Glucocorticoid Toxicity Index (GTI). The authors are from multiple institutions in England, the United States and Canada.
Patient selection: <= 18 years old on glucocorticoids
Parameters:
(1) cognitive impairment
(2) sleep impairment
(3) major mood disturbance
(4) infection
|
Parameter |
Finding |
Points |
|
cognitive impairment |
moderate impairment to none |
-20 |
|
|
moderate impairment to mild |
-11 |
|
|
mild impairment to none |
-9 |
|
|
no change |
0 |
|
|
none to mild impairment |
9 |
|
|
mild impairment to moderate |
11 |
|
|
none to moderate impairment |
20 |
|
sleep impairment |
major to none |
-35 |
|
|
major to minor |
-27 |
|
|
major to moderate |
-22 |
|
|
moderate to none |
-13 |
|
|
minor to none |
-8 |
|
|
moderate to minor |
-5 |
|
|
no change |
0 |
|
|
minor to moderate |
5 |
|
|
none to minor |
8 |
|
|
none to moderate |
13 |
|
|
moderate to major |
22 |
|
|
minor to major |
27 |
|
|
none to major |
35 |
|
mood disturbance |
major to none |
-57 |
|
|
major to minor |
-46 |
|
|
major to moderate |
-31 |
|
|
moderate to none |
-26 |
|
|
moderate to minor |
-15 |
|
|
minor to none |
-11 |
|
|
no change |
0 |
|
|
none to minor |
11 |
|
|
minor to moderate |
15 |
|
|
none to moderate |
26 |
|
|
moderate to major |
31 |
|
|
minor to major |
46 |
|
|
none to major |
57 |
|
infection |
Grade 3 or 4 to none |
-48 |
|
|
Grade 3 or 4 to Grade 1 or 2 |
-34 |
|
|
Grade 1 or 2 to none |
-14 |
|
|
no change |
0 |
|
|
none to Grade 1 or 2 |
14 |
|
|
Grade 1 or 2 to Grade 3 or 4 |
34 |
|
|
none to Grade 3 or 4 |
48 |
subscore =
= SUM(points for all 4 parameters)
Interpretation:
• minimum subscore: -160
• maximum subscore: 160
• The higher the subscore the greater the CNS toxicity and risk of infection
Specialty: Nutrition
