Diaphragmatic fenestration an effective treatment for refractory postoperative chylothorax: a case report

Postoperative chylothorax remains a clinical challenge to the surgeon with substantial morbidity and risk of mortality. Though an uncommon complication, it is known to complicate cardiac and non-cardiac thoracic surgeries. Conservative measures are first employed in managing this. Surgical options are adopted when the effusion is protracted, most recent of which includes diaphragmatic fenestration. A 9-year-old girl is presented who developed recurrent right chylothorax following thoracoscopic excision of a cystic lymphangioma. Following failed conservative therapy, she had thoracic duct ligation and right diaphragmatic fenestration (using fenestrated polytetrafluoroethylene patch) with satisfactory outcome. Aetio-pathologic mechanisms implicated in postoperative chylothorax have been classified into traumatic (iatrogenic injury to the thoracic duct or its branches) and non-traumatic. With initial conservative measures (repeated pleural aspirations and intercostal drainage, medium chain triglyceride/ low fat feeds or alternatively, fasting and total parenteral nutrition) spontaneous closure remains unpredictable. Diaphragmatic fenestration when employed resulted in faster resolution of effusion and earlier commencement of enteral feeding with no significant complication. Diaphragmatic fenestration is effective and safe for treating refractory post-operative chylothorax.

Pediatric risk of mortality III score in predicting mortality in children with altered sensorium in pediatric intensive care unit

Background: The Pediatric Risk of Mortality (PRISM) Score has been devised to predict outcome and risk of mortality. The PRISM III score is one of the most recent scoring systems of pediatric mortality. This was developed involving 32 PICUs. Physiological data included the most abnormal values from the first 12 and second 12 hours of the PICU stay. To evaluate the mortality rate in children with altered sensorium by applying PRISM III (pediatric risk of mortality) score.Methods: This study was done in the paediatric intensive care unit of the Department of Paediatrics, Government Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu, India on 100 children of both sexes aged between 1 month and 13 years. The study was carried out for a period from December 2017 to July 2018. PRISM III scoring scale was applied for every child in his/her first 24 hours of PICU admission and their calculated score was recorded into the proforma. The clinical details at admission, laboratory data were recorded into the proforma.Results: Three major groups that contributed to the bulk of the admissions were acute CNS infection, seizure disorder and, bites and stings. They constituted to around 54% of our total admissions. As PRISM III Score increases there is a steady increase in the mortality rate. This table shows that the mortality rate is 0% for the 0-9 group and that it increases to 100% for 20-29 and 30 and above groups as the PRISM III score increase.Conclusions: PRISM III score provides an objective assessment of the severity of illness. PRISM III, when performed well, is good to predict mortality in an Indian PICU. Scoring systems with fewer laboratory parameters will be more useful in author's context. Larger studies are needed to develop/validate a mortality prediction score for our country.

Prediction of the risk of mortality in paediatric intensive care unit using PRISM III score

Background: is the Pediatric risk of mortality (PRISM) score which has been devised by Pollock et al, to predict the mortality in hospitalized children. PRISM score is a revised form of physiologic stability index of mortality score.Methods: A observational prospective study was conducted at tertiary care hospital, Udaipur Rajasthan over period of March 2017 to September 2018. Total 207 patient were enrolled in study as per inclusion and exclusion criteria.Results: Total 29.92% had PRISM III score of 0 to 5, 25.45% had score of 6-10, 16.53% had score of 11-15, 13.12% had score of 16-20, 7.61% between 21 to 25, 4.72% between 26-30 and 2.62% had score of greater than 30. There was no mortality when the PRISM score of the child was between 0 to 5. The percentage of deaths increased progressively with increasing PRISM score.Conclusions: There was no significance difference in predicted from PRISM score and the actual death. The expected mortality was comparable to actual death, except in children who required mechanical ventilation and vasopressor drugs.

Paediatric Risk of Mortality III Score to Predict Outcome in Patients Admitted to PICU with Dengue Fever

Background: The objective of the current study was to evaluate the ability of PRISM III score calculated within 24 hours of PICU admission to predict outcome in patients with dengue fever. Materials & Methods: The prospective cohort study included children admitted to PICU with diagnosis of ‘Dengue with warning sign’ and ‘Severe Dengue’. Outcome included PICU mortality, length of PICU stay (LOS), need for mechanical ventilation and renal replacement therapy (RRT). PRISM III score was calculated and compared with outcome groups. Calibration of the score was measured using Hosmer‑Lemeshow modification of chi square test and discrimination using Area under the curve of Receiver Operating Characteristic curves. Results: This study included 151 patients with 54.3% Dengue with warning signs and 45.7% severe Dengue. Median PRISM III-24 score of patients who died (p-0.001), required RRT (p-0.006), mechanical ventilation (p-0.032) and those with prolonged LOS (p-0.003) were significantly higher. Hosmer‑Lemeshow modification of chi square test to assess calibration showed good fit of PRISM III-24 model to predict mortality (χ2-2.022; p-0.846), need for RRT (χ2-3.564; p-0.614), prolonged LOS (χ2-4.360; p-0.499) and need for mechanical ventilation (χ2-7.497; p-0.186).  ROC curve for the PRISM III-24 model to predict the discriminating power yield an AUC of 0.923 (95% CI: 0.829-1.000) for mortality, 0.953 (95% CI: 0.896-1.000) for need for RRT, 0.682 (95% CI: 0.494-0.870) for need for mechanical ventilation and 0.663 (95% CI: 0.563-0.764) for prolonged LOS. Conclusion: PRISM III is an effective tool to predict mortality and need for RRT in patient with dengue fever

Nutritional assessment in a pediatric intensive care unit / 中华急诊医学杂志

Objective To assess nutritional status of critically ill children,and to investigate the correlation of nutritional status with illness severity and clinical outcomes,so as to provide a theoretical basis for rational nutrition support of critically ill children.Methods All patients hospitalized in the pediatric intensive care unit of Beijing Children's Hospital from November,2010 to January 2011 were enrolled and studied prospectively.We collected anthropometric parameters (body length/height,body weight,head circumference,etc) for nutritional assessment,as well as their clinical data such as underlying diseases,pediatric risk of mortality scores (PRISM),length of hospital stay and mechanical ventilation duration.Results tn 196 cases,the prevalence of malnutrition was 21.9％ (43/196).Malnutrition group had greater PRISM scores,higher mechanical ventilation rate and a lower 28-day survival rate than normal nutritional status group (all P ＜ 0.05).Conclusions The prevalence of malnutrition on admission to the PICU was high and poor nutritional status indicated greater illness severity and adverse clinical outcomes

The performance of pediatric risk of mortality score in pediatric patients with severe hand,foot and mouth disease / 中国小儿急救医学

Objective To comment the severity of severe hand,foot and mouth disease(HFMD)by pediatric risk of mortality score(PRISM),and assess the performance of PRISM in predicting mortality or complication probability in HFMD.Methods Four hundred and twenty-four severe HFMD pediatric patients were recruited in the study from 1th Jan 2010 to 31th June 2013.Information on the outcome and the varia-bles required to calculate PRISM score were collected.The logistic regression model developed in the learning sample was evaluated in the test sample by calculating the area under the receiver operating characteristic (ROC)curve to assess discrimination pneumorrhagia and death.Calibration across deciles of risk was evalua-ted using the Hosmer-Lemeshow goodness-of-fit χ2 test.Results The area under the ROC curve were 0.87 (95%CI 0.80~0.94 )for PRISM in predicting pneumorrhagia probability.The area under the ROC curve were 0.87(95%CI 0.80~0.95)for PRISM in predicting mortality probability.The PRISM in observed and expected pneumorrhagia did not demonstrate good calibration at ten mortality risk intervals (χ2 =36.66, P<0.001 ).The PRISM in observed and expected mortality did not demonstrate good calibration at ten mortali-ty risk intervals(χ2 =41.11,P<0.001).Conclusion The PRISM score is demonstrated good discrimination of pneumorrhagia and death in HFMD pediatric patients,but the performance of calibration is not good.

Accuracy of Risk Assessment Tool in Predicting Pneumonia’s Outcome among Egyptian Children: Hospital Based Study.

Aim:To determine possible factors associated with lethal outcome of pneumonia and to assess the accuracy of Pneumonia Severity Index (PSI) and Pediatric Risk of Mortality (PRISM) score in predicting mortality from pneumonia. Study Design: A retrospective analytical study Place and Duration of the Study: Pediatric Emergency Department (PED) of the pediatric hospital (Abu El-Reesh) Egypt, during a period from April 2010 to April 2012. Methodology: Children ≤5 years admitted to the PED diagnosed having pneumonia were included in the study (n=236). Data were retrieved from the electronic records and consisted of; hospital data, personal data, provisional and definite diagnosis, presenting clinical symptoms and signs, outcome and measurements of blood counts and serum biochemical markers. Results: Non-survivors constituted 26.7% of the studied group. Non-survivors significantly had a higher median PRISM score (18; IQR 11 for non-survivors compared to 8; IQR 6 for survivors, P =.000), have a longer median length of stay (8 days; IQR; 1 day for non-survivors compared to 4 days; IQR 2 days for survivors, P =.000), higher PSI score (61; IQR 39 for non-survivors compared to 41; IQR 20 for survivors, P =.000).Only longer LOS, higher PRISM score were independently associated with mortality. ROC curve analysis revealed area under the curve (AUC) of 0.857 for PRISM score (95% CI 0.80–0.91) and 0.73.6 for PSI score (95% CI 0.66–0.81). A PRISM score ≥ 12.5 is 81.4% sensitive and 73.3% specific in predicting mortality. Conclusion: Case fatality rate is quite high. PRISM scoring is accurate in predicting mortality among pneumonia pediatric patients and thus useful in decision making concerning management of these cases.

Clinical evaluation with pediatric clinical illness scores and pediatric risk of mortality in PICU / 中国小儿急救医学

Objective To evaluate the use of pediatric clinical illness score(PCIS) and pediatric risk of mortality(PRISM) in severe cases in pediatric intensive care unit(PICU). Methods 580 patients were divid-ed into groups according to PICS results, death and the numbers of organ failure. Severity, mortality were ana-lyzed. PRISM scores were also investigated in these groups respectively. Results The PRISM score of the ex-tremely-severe group was higher than that of the severe group and the non-severe group(P<0.01). The mean value of scores in death group was higher than that in survival group(P<0.01). The PRISM scores was in-creasing along with the growing numbers of organ failure (P<0.05). Conclusion Both PCIS and PRISM scores have good clinical value in assessing the severity and risk of death in patients in PICU.

Roles of Pediatric Critical Illness Score and Pediatric Risk of Mortality Score in Children with Acute Respiratory Distress Syndrome and the Correlation between Them / 实用儿科临床杂志

Objective To explore the prognostic value of pediatric critical illness score(PCIS)and pediatric risk of mortality score(PRISMⅢ)and the accuracy for evaluating the state of children with acute respiratory distress syndrome(ARDS).Methods Seventy-one cases hospitalized children from 29 days to 14 years old of Hebei ARDS cooperation group were selected during the 13 months between 2005 and 2006.All cases were confirmed according to ARDS diagnostic standard.For prospective studies,the patients were scored simultaneously with PCIS and PRISMⅢ at different times:when the patients entered PICU,when the patients were in the worst situation in PICU,when the patients were diagnosed as ARDS and when ARDS was serious.The data were performed by using Logistic regression etc.Results Values of Logistic regression were P

Clinical Application of Pediatric Risk of Mortality Score in Pediatric Intensive Care Unit / 实用儿科临床杂志

15, the mortality was38.1%(n = 8).There was significantly difference both in mortality (x2 = 4.14 P