The Zinner index was modified by Lugo et al for use with children in the pediatric intensive care unit to predict the risk for acute upper gastrointestinal hemorrhage. A child at high risk for bleeding may benefit from prophylactic measures to reduce the risk.
Patient population: children in the intensive care unit (ICU)
Number of systems in index: 10
|
System |
Criteria |
|
respiratory |
respiratory insufficiency (requiring nasal CPAP or mechanical ventilation); OR > 24 hours of mechanical ventilation during the postoperative period |
|
shock |
at least 2 of the following: hypotension with systolic blood pressure < -2 SD below mean for age, oliguria, poor peripheral perfusion; OR inotropic drugs required to maintain blood pressure or cardiac output |
|
sepsis |
at least 2 of the following: clinical symptoms; leukocytosis or leukopenia; positive blood cultures |
|
heart failure |
acute heart failure OR significant arrhythmia requiring drugs or pacemaker to control |
|
acute renal failure |
creatinine > 2 times upper limit of normal reference range for age, OR BUN > 2 times upper limit of normal reference range for age |
|
neurologic alterations |
obtunded mental status OR coma OR seizures |
|
steroid use |
methylprednisone > 2 mg/kg per day, or equivalent |
|
coagulation disorders |
platelet count < 50,000 per µL, OR a prothrombin activity of < 50% OR DIC |
|
liver alterations |
bilirubin > 5 mg/dL, OR AST > 2 times upper limit of normal reference range OR ALT > 2 times upper limit of normal reference range |
|
metabolic acidosis |
arterial pH < 7.3 with plasma bicarbonate < 17 mmol/L |
where:
• Prothrombin activity may not be readily available. I've substituted a prothrombin time (PT) > 2 times the upper limit of the normal reference range.
number of risk factors =
= SUM(criteria present)
Interpretation:
• minimum score: 0
• maximum score: 10
• The higher the score the greater the risk for upper gastrointestinal hemorrhage.
|
Number of Risk Factors |
Frequency Upper GI Hemorrhage |
|
0 – 2 |
4.6% |
|
3 – 6 |
25.8% |
|
7 - 10 |
54.5% |
after Table 5, page 1088, Lopez-Herce (1992)
Specialty: Gastroenterology
