TOPRSS: a simple clinical score to predict outcome and mortality in paediatric emergency department

Trishya Reddy S., D. Venkatapathy Raja


Background: To validate the clinical scoring system TOPRSS for the severity of the illness to prioritize care and predict outcomes in the emergency department.

Methods: This prospective hospital-based observational study in 100 children for three months carried out. Cases<1-month age or>14 years excluded. Demographics data, provisional diagnosis, hemodynamics, seizures, and other clinical parameters were recorded on predesigned proforma at the time of admission. Final outcome of the patient, either discharge or death, was considered as the primary variable.

Results: Out of 100 children, 92 were discharged and 8 deaths were recorded. Of the six variables, oxygen saturation and sensorium were found to be significantly associated with mortality. Logistic regression found that variables such as oxygen saturation and sensorium were strongly associated with mortality with a highly significant p value of 1% and variables such as pulse rate and seizures were also associated with mortality with a significant P value of 5%.

Conclusions: For triage in pediatric emergency, a patient with two or more abnormal variables should be evaluated to facilitate admission as they have a potential risk of death. TOPRSS score being a simple clinical scoring system which does not require any expertise can applied at all levels of health care to identify critically ill patient referral to higher centre especially in regions of resource poor environment.


Mortality, Oxygen saturation, Sensorium, TOPRSS score

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Shann F, Pearson G, Slater A, Wilkinson K. Pediatric index of Mortality (PIM): A mortality prediction model for children in intensive care. Intensive Care Med. 1997;23(2):201-7.

Morley CJ, Thornton AJ, Cole TJ, Hewson PH, Fowler MA. Baby check: a scoring system to grade the severity of acute systemic illness in babies under 6 months old. Arch Dis Child. 1991;66(1):100-5.

Mc Weeny PM, Emery JL. Unexpected post neonatal deaths (cot deaths) due to recognizable disease. Arch Dis Child. 1975;50(3):191-6.

de Courcy-Wheeler RH, Wolfe CD, Fitzgerald A, Spencer M, Goodman JD, Gamsu HR. Use of the CRIB (clinical risk index for babies) Arch Dis Child. 1995;73(1):F32-F36.

Kadivar M, Sagheb S, Bavafa F, Moghadam L, Eshrati B. Neonatal mortality risk assessment in a neonatal intensive care unit (NICU) Iran J Pediatr. 2007;17(4):325-31.

Sun D, Aikawa N. The natural history of the systemic inflammatory response syndrome and the evaluation of SIRS criteria as a predictor of severity in patients hospitalized through emergency services. Keio J Med. 1999;48(1):28-37.

Mackway-Jones K, Molyneux E, Phillips B, Weeteska S. The Practical Approach. BMJ books. 3rd ed. London: Panther publishers; 2001. Advanced Pediatrics Life support; pp. 71-8.

Yeh TS, Pollack MM, Ruttimann UE, Holbrook PR, Fields AI. Validation of a Physiologic Stability Index for use in critically iII infants and children. Pediatric Res. 1984;18(5):445-51.

Pollack MM, Ruttimann UE, Getson PR. The pediatric risk of Mortality (PRISM) scores. Crit Care Med.1988;16(11):1110-6.

Slater A, Shann F, Pearson G. Pediatric Index of Mortality (PIM) Study Group: PIM 2: a revised version of the Pediatric Index of Mortality. Intensive Care Med. 2003;29(2):278-85.

hompson M, Coad N, Harnden A, Mayon-White R, Perera R, Mant D. How well do vital signs identify children with serious infections in paediatric emergency care? Arch Dis Child. 2009;94(11):888-93.

Gove S, Tamburlini G, Molyneux E, Whitesell P, Campbell H. Development and simplified basis of simplified guidelines for emergency triage assessment and treatment in developing countries. Arch Dis Child. 1991;81(6):473-7.

Vasudevan A, Malhotra A, Lodha R, Kabra SK. Profile of neonates admitted in pediatric ICU and validation of Score for Neonatal Acute Physiology (SNAP). Indian Pediatrics. 2006;43(4):344.

Kumar N, Thomas N, Singhal D, Puliyel JM, Sreenivas V. Triage score for severity of illness, Indian Pediatrics. 2003;40:204-10.

Bhal S, Tyagi V, Kumar N, Sreenivas V, Puliyel JM. Signs of inflammation in children that can kill (SICK score):Preliminary prospective validation of a non –invasive measure of severity of illness. J postgrad Med. 2006;52:102-5.

Thompson M, Coad N, Harnden A, Mayon-White R, Perera R, Mant D. How well do vital signs identify children with serious infections in paediatric emergency care? Arch Dis Child. 2009;94(11):888-93.

Gupta MA, Chakrabarty A, Halstead R, Sahni M, Rangasami J, Puliyel A, et al.. Validation of" Signs of Inflammation in Children that Kill"(SICK) score for immediate non-invasive assessment of severity of illness. Italian Journal of Pediatr. 2010;36(1):1-6.

Bains HS, Soni RK. A Simple Clinical Score “TOPRS” to Predict Outcome in Pediatric Emergency Department in a Teaching Hospital in India, Ir J Paedia. 2012;22(1):97-101.