Archives of disease in childhood
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To investigate the prognostic value of intramucosal pH (pHi) and the relation among pHi, arterial pH, base excess, and lactate in children with septic shock. ⋯ In children with septic shock the admission pHi is significantly lower in non-survivors. pHi is a better prognostic indicator of mortality than either standard acid-base values or lactate. pHi < 7.32 that does not improve within six hours is associated with a poor prognosis.
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James' adaptation of the Glasgow coma scale (JGCS) was designed for young children. Intubated patients are not allocated a verbal score, however, so important changes in a patient's conscious level may be missed. A grimace score was therefore developed and assessed for use in intubated children. ⋯ Seventy three children had 104 sets of observations. Interobserver reliability was moderate to good for all components, with the grimace score better than the verbal score. It is concluded that the grimace score is more reliable than the verbal score and may be useful in intubated patients in whom the verbal score cannot be used.
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Multicenter Study
Validation of the paediatric appropriateness evaluation protocol in British practice.
The reliability and validity of the North American paediatric appropriateness evaluation protocol (PAEP) for use in paediatric practice in Britain was tested. The protocol was applied to 418 case records of consecutive emergency admissions to three Yorkshire district general hospitals. The PAEP ratings were then compared with a clinical consensus opinion obtained from two expert panels. ⋯ Validity of the PAEP, as measured by agreement beyond chance with the expert panel rating, was only moderate with a kappa of 0.29 (95% confidence interval 0.11 to 0.47). The PAEP has limited validity for evaluating British paediatric practice. Utilisation review instruments developed in differing clinical cultures should be used with caution until shown to be valid for the practice setting under review.
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To assess the value of sequential lactate measurement in predicting postoperative mortality after surgery for complex congenital heart disease in children. ⋯ Initial lactate concentrations have poor positive predictive value for mortality. The routine measurement of lactate for this purpose cannot be justified in clinical practice.