The New England journal of medicine
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We surveyed nine pediatric intensive care units (ICUs) to compare patient populations and to test prospectively the hypothesis that differences in mortality rates were due to differences in severity of illness. Age, clinical service, the reason for admission (emergency or scheduled), and the seriousness of the underlying chronic disease were recorded on admission. The severity of illness was assessed on the day of admission with a physiology-based measure, the Physiologic Stability Index. ⋯ Mortality rates also differed significantly (range, 3.0 to 17.6 percent; P less than 0.0001), as did the Physiologic Stability Index scores (P less than 0.0001). The mathematical function based on the Physiologic Stability Index score and on age reliably predicted the outcomes in all ICUs. We conclude that differences in mortality rates among pediatric ICUs can be explained by differences in the severity of illness.
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To determine the timing of symptoms and oocyst excretion after the acquisition of cryptosporidium infection, we used a screening parasitologic stool examination to identify patients and then contacted them for the collection of retrospective histories and follow-up stool specimens. The study included 68 otherwise healthy patients with an identifiable source and time of infection. All 68 had diarrhea, 61 had abdominal pain, most also had other gastrointestinal symptoms, 33 had fever, and all recovered spontaneously. ⋯ Fourteen patients were studied for two or more months, and in three of them asymptomatic episodes of oocyst excretion were detected up to two months after clinical recovery. We conclude that many cases of symptomatic cryptosporidiosis occur among immunocompetent patients, some of whom may excrete oocysts even when they have become asymptomatic. Conversely, infected symptomatic patients may occasionally have intermittently negative stools.