simple clinical score "TOPRS" to predict outcome in pediatric emergency department in a teaching hospital in India

To develop a simple clinical scoring system for severity of illness to help prioritize care and predict outcome in emergency department. Prospective hospital based observational study. Out of a total of 874 children who attended emergency department in one year, 777 were included in the study. Data was collected at the time of admission in emergency department. The baseline information like age, gender, etc and variables of 'toprs' score viz temperature, oxygen saturation, pulse rate, respiratory rate, sensorium and seizures were recorded. Variables were categorized as normal [score zero] or abnormal [score 1] based on systemic inflammatory response syndrome [SIRS] criteria and criteria mentioned in advanced pediatric life support [APLS] and the total scores were computed for each child. The outcome [death/discharge] was correlated with the study variables and total score. The predictive ability of score was calculated using receiver operating characteristic [ROC] curve analysis. Of the six variables, temperature, oxygen saturation and respiratory rate were found to be significantly associated with mortality. Mortality increased with the increase in the number of abnormal variables. Based on the regression coefficients, maximum possible score was 6.68. The predictive ability of score was 81.7 calculated using ROC curve. Maximum discrimination was observed at a score of 2.5. For triage in emergency, any patient with 2 or more abnormal variables should be closely monitored and evaluated. These patients require admission as they have a potential risk of death

Clinical profile and outcome in children of dengue hemorrhagic fever in north India

The number of dengue fever [DF]/dengue hemorrhagic fever [DHF] cases reported in India has risen in recent years. This study was undertaken to evaluate clinical profile and outcome of children admitted with DHF/dengue shock syndrome [DSS], in the 2006 DHF epidemic in Ludhiana, Punjab. Eighty one children with dengue hemorrhagic fever were hospitalized in the Pediatric Department of Dayanand Medical College and Hospital, Ludhiana, India. All patients were diagnosed, managed and monitored according to a standard protocol. Children between 10-15 years were most commonly afflicted [59%]. Infants were the least affected sub-group [3.7%]. Ninety two percent of all children were of DHF and 8% cases presented in DSS. The common symptoms seen were fever [91%], vomiting [41%], poor intake [21%], abdominal pain [16%] and significant bleeding [15%]. Hepatomegaly was present in 60% of cases. 85% of cases had petechiae alone, 15% had evidence of significant bleeding manifestation. Gastrointestinal bleeding was the commonest observed bleeding. The complications seen were liver dysfunction [14.8%], coagulopathy [3.7%], renal dysfunction [3.7%], and acute respiratory distress syndrome [2.4%] and disseminated intravascular coagulation [1.2%]. Mortality in the study was 3.7%. Refractory shock and coagulopathy were seen in all cases with poor outcome. Increased awareness, better transport facilities and case management according to the WHO guidelines, is needed to further reduce mortality of DHF/DSS cases