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Unnecessary harm is avoided by reliable paediatric index of mortality2 scores without arterial gas sampling
Author(s) -
Kalzén Håkan,
Hannegård Hamrin Tova,
Lindberg Lars,
Ingemanson Ola,
Radell Peter J.,
Eksborg Staffan
Publication year - 2019
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.14580
Subject(s) - medicine , fraction of inspired oxygen , arterial blood , pediatrics , arterial oxygen tension , arterial blood gas analysis , emergency medicine , anesthesia , mechanical ventilation , lung
Abstract Aim To investigate whether unnecessary harm could be avoided in children admitted to paediatric intensive care ( PICU ), we analysed the impact of arterial blood gas on the paediatric index of mortality score2 ( PIM 2) and the derived predicted death rate ( PDR ). Methods From January 1, 2008 to December 31, 2010, 1793 consecutive admissions, newborn infants to 16 years of age (median 0.71 years) from a single, tertiary PICU in Gothenburg Sweden, were collected. Admission information on arterial oxygen tension (PaO 2 ) and fraction of inspired oxygen (FiO 2 ) was extracted from 990 admissions. Results There was close agreement between PIM 2 score and PDR regardless of whether the PaO 2 /FiO 2 ratio was omitted or not. In the subgroup of admissions with a respiratory admission diagnosis, the inclusion of the PaO 2 /FiO 2 ratio increased the accuracy of the PIM 2 score as well as the PDR . The standard mortality ratio was slightly but not significantly overestimated by excluding the PaO 2 /FiO 2 ratio. Conclusion To avoid unnecessary harm to children admitted to PICU , an arterial blood gas analysis should only be performed if clinically indicated or if the child has a respiratory admission diagnosis. Estimation of the PIM 2 score and PDR will not be less accurate by this approach.