Nariadhara Meera R, Sawe Hendry R, Runyon Michael S, Mwafongo Victor, Murray Brittany L
1Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania.
2Emergency Medicine Department, Muhimbili National Hospital, Dar Es Salaam, Tanzania.
Trop Med Health. 2019 Feb 1;47:13. doi: 10.1186/s41182-019-0136-y. eCollection 2019.
Modified systemic inflammatory response syndrome (mSIRS) criteria for the pediatric population together with the provider gestalt have the potential to predict clinical outcomes. However, this has not been studied in low-income countries. We investigated the ability of mSIRS and provider gestalt to predict mortality and morbidity among children presenting to the ED of a tertiary level hospital in Tanzania.
This prospective observational study enrolled a convenience sample of children under 5 years old, presenting to the Emergency Medicine Department of Muhimbili National Hospital from September 2015 to April 2016. Trained researchers used a structured case report form to record patient demographics, clinical presentation, initial provider gestalt of severity of illness, and the mSIRS criteria. Primary outcomes were 24-h mortality and overall in-hospital mortality. Data was analyzed using simple descriptive statistics, Kruskal-Wallis, Mann-Whitney , and chi-squared tests.
We enrolled 1350 patients, median age 17 months (interquartile range 8-32 months), and 58% were male. Provider gestalt estimates of illness severity were recorded for all patients and 1030 (76.3%) had complete data for mSIRS categorization. Provider gestalt classified 97 (7.2%) patients as healthy, 546 (40.4%) as mildly ill, 457 (33.9%) as moderately ill, and 250 (18.5%) as severely ill. Of the patients, classifiable by mSIRS, 411/1030 (39.9%) had ≥ 2 mSIRS criteria. In predicting 24-h mortality, the ≥ 2 mSIRS and gestalt "severely ill" had sensitivities of 82% and 81%, respectively, and specificity of 61% and 84%, respectively. In predicting overall in-hospital mortality, the ≥ 2 mSIRS and gestalt "severely ill" had sensitivities of 66% and 70% with a specificity of 62% and 86% respectively.
Both the mSIRS and provider gestalt were highly specific for predicting 24-h and overall in-hospital mortality in our patient population. The clinical utility of these assessment methods is limited by the low positive predictive value.
针对儿科人群的改良全身炎症反应综合征（mSIRS）标准以及医疗人员的整体判断有可能预测临床结局。然而，在低收入国家尚未对此进行研究。我们调查了mSIRS和医疗人员的整体判断在坦桑尼亚一家三级医院急诊科就诊儿童中预测死亡率和发病率的能力。
这项前瞻性观察性研究纳入了2015年9月至2016年4月在穆希姆比利国家医院急诊科就诊的5岁以下儿童的便利样本。经过培训的研究人员使用结构化病例报告表记录患者的人口统计学信息、临床表现、医疗人员对疾病严重程度的初始整体判断以及mSIRS标准。主要结局为24小时死亡率和院内总死亡率。使用简单描述性统计、Kruskal-Wallis检验、Mann-Whitney检验和卡方检验对数据进行分析。
我们纳入了1350名患者，中位年龄17个月（四分位间距8 - 32个月），58%为男性。记录了所有患者医疗人员对疾病严重程度的整体判断，1,030名（76.3%）患者有完整的mSIRS分类数据。医疗人员的整体判断将97名（7.2%）患者分类为健康，546名（40.4%）为轻症，457名（33.9%）为中症，250名（18.5%）为重症。在可通过mSIRS分类的患者中，411/1,030名（39.9%）有≥2条mSIRS标准。在预测24小时死亡率时，≥2条mSIRS标准和整体判断“重症”的敏感度分别为82%和81%，特异度分别为61%和84%。在预测院内总死亡率时，≥2条mSIRS标准和整体判断“重症 ”的敏感度分别为66%和70%，特异度分别为62%和86%。
mSIRS和医疗人员的整体判断在预测我们研究人群的24小时和院内总死亡率方面均具有较高的特异度。这些评估方法的临床实用性受到低阳性预测值的限制。
