DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20211069

Assessment of severity of illness on admission using SICK score and evaluation of the risk factors associated with mortality in children admitted in a paediatric urban tertiary care centre in south India

N. Rajeshwari, A. Savitha, J. Prahada

Abstract


Background: “Signs of inflammation that can kill” (SICK) score is one of the severities scoring systems used for predicting outcome of children at admission. The aim of the present study was to study the clinical and demographic profile of children admitted to Paediatric ward, to assess the usefulness of SICK score in predicting the mortality and evaluate the risk factors in predicting mortality.  

Methods: SICK scoring was done for 369 children on admission. The outcome was recorded as death or discharge. The associated factors were analysed using SPSS software package analysis. Receiver operating curve was used to arrive at the cut-off point of SICK score for predicting mortality. Quantitative data differences between children who died and children who were discharged from the hospital were analysed using student independent t test. Need for assisted ventilation, presence of shock, age less than 3 years, and SICK score>2 were studied to find their association with mortality. Statistical analysis was done using univariate analysis and those factors that were significantly associated with mortality were subjected multivariate logistic regression analysis.

Results: The performance of SICK score was “excellent” in discriminating between death and survival with area under the receiver operating characteristics curve 0.94. Age<3-year presence of shock, need for mechanical ventilation and SICK score>2 showed statistically significant association with mortality as evidenced by multivariate logistic regression model.  

Conclusions: SICK score performed extremely well in predicting mortality on admission. Age<3 years, SICK score>2, Presence of Shock and need for assisted ventilation showed statistically significant association with mortality.


Keywords


SICK score, Mortality, Early intervention, Mechanical ventilation, Shock

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References


Chang L, Horng CF, Huang YC, Hsieh YY. Prognostic accuracy of acute physiologic and chronic health evaluation II scores in critically ill cancer patients. Am J Crit Care 2006;15:47-53.

TibbySM, TaylorFesta M, Hanna S, HatherillM, JonesG, et al. A comparison of three scoring systems for mortality risk among retrieves intensive care patients. Arch Dis Child. 2002;87:421-5.

Qureshi AU, Ali AS, Ahmad TM. Comparison of three prognostic scores (PRISM, PELOD AND PIM2) atpaediatric intensive care unit under Pakistani circumstances. J Ayub Med Coll Abbottabad. 2007;19:49-53.

Costa GA, Application of the paediatric risk of mortality score and determination of mortality risk factors in a tertiary paediatric intensive care unit. Clinics (Sao Paulo). 2010;65:1087-82.

Martha et al. Comparison of two prognostic scores (PRISM and PIM) at a paediatric intensive care unit. J Paediatric Rio J. 2005;81:259-64.

Kumar N, Thomas N, Singhal D, Pulliyel JM, Srinivas V. Triage score for severity of illness. Indpaediatrics 2003; 40:204-10.

Gupta MA, Chakrabarty A, Halstead R, SahniM, Rangasami J, Puliyel A, et al. Validation of Signs of Inflammation in Children that can Kill (SICK) score for immediate non-invasive assessment of severity of illness. Italian J Padiatr. 2010;36(1):35.

Typpo KV, Larmonier CB, Deschenes J. Clinical characteristics associated with postoperative intestinal epithelial barrier dysfunction in children with congenital heart disease, Paed Crit Care Med 2015;16:37-44.

Gandhi J, Sangareddi S, Varadarajan P, Suresh S. Pediatric index of mortality 2 score as an outcome predictor in pediatric Intensive Care Unit in India. Ind J Citic Care Med. 2013;17(5):288.

Ajlabari S, Balch A, LarsenGY, etal. Severe sepsis -associated morbidity and mortality among critically ill children with cancer. J Paed Intensive Care. 2019;8:122-9

Costa PdeO, Atta EH, Silva ARA da. Predictors of 7- and 30 – day mortality in paediatric intensive care unit patients with cancer and haematological malignancy infected with gram 0-negative bacteriuria. J Infect Dis 2014;18:591-9

Dettmer MR, Damuth E, Zarbiv S. Prognostic factors for long term mortality in critically ill patients treated with prolonged mechanical ventilation: a systematic review. Crit Care Med 2017;45:69-74

Sari DSP, Saptura I, Triratna S. The paediatric index of mortality 3 score to predict mortality in a paediatric intensive care unit in Palembang, South Sumatera, Indonesia. Paediatr Indones. 2017;57:164-70

Teshager NW, Amare AT, Tamirat KS. Incidence and predictors of mortality among children admitted to the paediatric intensive care unit at the university of Gondar comprehensive specialised hospital, northwest Ethiopia: a prospective observational study. Bio Med J Open. 2020;10:e036746.