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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2022.tde-09112022-113833
Document
Author
Full name
Vanessa de Arruda Santos
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2022
Supervisor
Committee
Carmona, Fabio (President)
Miranda, Carlos Henrique
Portugal, Carolina Augusta Arantes
Title in Portuguese
Validação de um método automatizado de cálculo de escores preditores de mortalidade pediátrica PRISM IV (Pediatric Risk of Mortality) e PIM 3 (Pediatric Index of Mortality) em uma unidade de terapia intensiva pediátrica
Keywords in Portuguese
Escore mortalidade
Morbidade pediátrica
Mortalidade pediátrica
Unidade de terapia intensiva pediátrica
Abstract in Portuguese
Há décadas têm-se usado nas Unidades de Terapia Intensiva (UTI) escores de gravidade das doenças e mortalidade. Os mais frequentemente utilizados nas UTIs pediátricas são os escores PRISM (Pediatric Risk of Mortality) e PIM (Pediatric Index of Mortality). Esses foram inicialmente desenvolvidos a partir de variáveis fisiológicas associadas a maior risco de mortalidade. O principal uso para esses escores consiste nas avaliações de qualidade da assistência das UTIs. Esse trabalho consistiu no desenvolvimento e implementação de formulário eletrônico desenvolvido no sistema de prontuário eletrônico de um hospital universitário brasileiro. Trata-se de estudo observacional do tipo transversal. Dados foram coletados retrospectivamente de janeiro a fevereiro, e prospectivamente de março a abril de 2021. As variáveis foram coletadas em sistema eletrônico diretamente do prontuário dos pacientes. Foram revisados dados de 132 pacientes. Desses, 29 foram excluídos por apresentarem idade inferior a 28 dias ou quando o cálculo dos escores não foi possível. Os escores PRISM IV e PIM 3 foram calculados manualmente e usando o formulário eletrônico, e a concordância entre os dois cálculos foi avaliada. Dos 111 casos efetivamente incluídos na pesquisa, 51,7% eram do sexo feminino. A distribuição de risco inicial de morte foi a seguinte: 11,1% baixo risco, 66,7% alto risco, e 22,2% muito alto risco. Cerca de 45% das admissões foram não eletivas. Quanto à origem dos pacientes, 55,2% foram provenientes do centro cirúrgico, 6,9% da sala de urgência, 20,7% da enfermaria pediátrica e 17,2% de outros hospitais. Entre as admissões pós-operatórias, 65,6% eram não cardíacos. Houve 100% de concordância entre os escores calculados pelos formulários criados no sistema (software) e o formulário oficial dos escores PRISM IV e PIM 3. Estabeleceu-se boa concordância entre escores calculados manualmente e calculados pelo software, permitindo futuramente comparar qualidade e efetividade de atendimento prestado com maior praticidade. Além do mais, permitirá alocação diferenciada de recursos tecnológicos e de pessoal, intensificação da terapêutica e antecipação de medidas.
Title in English
Validation of an automated method for calculating predictor scores for pediatric mortality PRISM IV (Pediatric Risk of Mortality) and PIM 3 (Pediatric Index of Mortality) in a pediatric intensive care unit
Keywords in English
Mortality score
Pediatric intensive care unit
Pediatric morbidity
Pediatric mortality
Abstract in English
Scores have been used for decades to predict disease severity and outcomes in Intensive Care Units (ICU). The most frequently score used in pediatric ICUs are the PRISM (Pediatric Risk of Mortality) and the PIM (Pediatric Index of Mortality) scores. These scores were initially developed from physiological variables associated with the risk of mortality. Currently, these scores are mostly used to assess the quality of care in ICUs, as they are significantly associated with morbidity and mortality. However, calculating these scores manually can be time-consuming for staff. This study aimed at validating an electronic form that calculates PRISM IV and PIM 3 scores in the medical records system of a Brazilian university hospital. It was an observational cross-sectional study. Data were collected retrospectively from January to February 2021, and prospectively from March to April 2021. The variables were collected in an electronic system directly from the patients records. Data from 132 patients were reviewed, of which 29 were excluded due to age of 28 days of life or less or because score calculation was deemed impossible. PRISM IV and PIM 3 scores were calculated manually and using the electronic form, and the agreement between the two calculations was determined. Thereby, 111 patients were effectively included in the study, of which 51.7% were female. The distribution of the initial risk of death was as follows: 11.1% low risk, 66.7% high risk, and 22.2% very high risk. About 45% of admissions were non-elective. As for the origin of the patients, 55.2% came from the operating room, 6.9% from the emergency room, 20.7% from the pediatric ward, and 17.2% from other hospitals. Among postoperative admissions, 65.6% were non-cardiac. There was 100% agreement between the scores calculated by the forms in the system (software) and the official form for the PRISM IV and PIM 3 scores, establishing good agreement between scores calculated manually and calculated using the software, allowing future comparison of quality and effectiveness of care provided with greater practicality. Furthermore, it will allow differentiated allocation of technological and personnel resources, intensifying therapy and anticipating measures.
 
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Publishing Date
2022-11-24
 
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