Articles: intensive-care-units.
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Bol Med Hosp Infant Mex · Dec 1993
Comparative Study[The validity of the index of pediatric mortality risk (PRISM) in a pediatric intensive care unit].
With the purpose to compare the observed and expected mortality rates (based on the PRISM score) in the Pediatric Intensive Care Unit (PICU) of the "Hospital para el Niño Poblano", a prospective study of 92 patients admitted from August to December of 1992 was made. More than five percent of mortality risk was observed among 60.2% of the patients at the PICU admittance. ⋯ We observed that seven of ten patients who died with less than 50% mortality risk, had inotropic treatment previously to PICU admittance, there was no haemodynamic alterations in these patients at the PICU admittance, and the PRISM score was low. We suggest that the PRISM score should be interpreted with caution in those patients whose treatment may change the physiologic variables included in the PRISM score.
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To formulate recommendations for the development of early intensive care unit (ICU) discharge criteria for low-risk monitor patients. ⋯ Objective methods (such as APACHE III) should be used to identify low-risk patients at 24 h post-ICU admission. A multicenter study should be conducted to compare outcomes on patients identified as low risk who are randomly assigned to alternative hospital locations for treatment versus those assigned to continued ICU treatment until routine ICU discharge. Mortality and quality of life data should be used as outcome measures (prior to ICU admission and 6 months post-ICU discharge).
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To formulate recommendations for the development of intensive care unit (ICU) admission policies. ⋯ The use of decision-making models for ICU and CCU admissions must be tested in prospective, randomized clinical trials. Critical care units and ICUs should be studied separately. Existing studies of early discharge from CCUs need to be summarized and evaluated. The triaging of ICU patients to alternative hospital locations needs to be evaluated, as do existing predictive models for early triage decision-making.