Background: The pediatric resuscitation and trauma outcome (PRESTO) model was developed to aid comparisons of risk-adjusted mortality after injury in low- and middle-income countries (LMICs). We sought to validate PRESTO using data from a middle-income country (MIC) trauma registry and compare its performance to the Pediatric Trauma Score (PTS), Revised Trauma Score, and pediatric age-adjusted shock index (SIPA).
Methods: We included children (age < 15 years) admitted to a single trauma center in South Africa from December 2012 to January 2019. We excluded patients missing variables necessary for the PRESTO model-age, systolic blood pressure, pulse, oxygen saturation, neurologic status, and airway support. Trauma scores were assigned retrospectively. PRESTO's previously high-income country (HIC)-validated optimal threshold was compared to MIC-validated threshold using area under the receiver operating characteristic curves (AUROC). Prediction of in-hospital death using trauma scoring systems was compared using ROC analysis.
Results: Of 1160 injured children, 988 (85%) had complete data for calculation of PRESTO. Median age was 7 (IQR: 4, 11), and 67% were male. Mortality was 2% (n = 23). Mean predicted mortality was 0.5% (range 0-25.7%, AUROC 0.93). Using the HIC-validated threshold, PRESTO had a sensitivity of 26.1% and a specificity of 99.7%. The MIC threshold showed a sensitivity of 82.6% and specificity of 89.4%. The MIC threshold yielded superior discrimination (AUROC 0.86 [CI 0.78, 0.94]) compared to the previously established HIC threshold (0.63 [CI 0.54, 0.72], p < 0.0001). PRESTO showed superior prediction of in-hospital death compared to PTS and SIPA (all p < 0.01).
Conclusion: PRESTO can be applied in MIC settings and discriminates between children at risk for in-hospital death following trauma. Further research should clarify optimal decision thresholds for quality improvement and benchmarking in LMIC settings.
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http://dx.doi.org/10.1007/s00268-020-05512-3 | DOI Listing |
PLoS Negl Trop Dis
January 2025
Department of Infectious Diseases, Children's Hospital 2, Ho Chi Minh City, Vietnam.
Background: Severe respiratory distress and acute kidney injury (AKI) are key factors leading to poor outcomes in patients with dengue shock syndrome (DSS). There is still limited data on how much resuscitated fluid and the specific ratios of intravenous fluid types contribute to the development of severe respiratory distress necessitating mechanical ventilation (MV) and AKI in children with DSS.
Methodology/principal Findings: This retrospective study was conducted at a tertiary pediatric hospital in Vietnam between 2013 and 2022.
Resusc Plus
June 2024
Departments of Pediatrics and Emergency Medicine, University of Calgary, Alberta, Canada.
Aim: This scoping review aimed to identify potential variables influencing healthcare provider's perceived workload or stress when performing resuscitation on patients in cardiac arrest.
Methods: We searched Medline, EMBASE, PsycINFO, Cochrane, and Allied Health Literature (CINAHL) to identify studies published prior to February 1, 2024. We used a PECO format for this review: the population were healthcare providers performing resuscitation during simulated or real cardiac arrest; the exposure was the presence of any factor that could impact perceived workload or stress; and the comparator was the absence of any specific factor.
BMJ Open
January 2025
Evidence based medicine center, Lanzhou University, Lanzhou, Gansu, China.
Unlabelled: Prophylactic respiratory support for patients after extubation is effective in improving their outcomes and prognosis. However, the optimal post-extubation respiratory support for different populations and disease types of mechanically ventilated patients remains controversial, and there is a lack of detailed, multidisciplinary, evidence-based recommendations for clinical application.
Methods And Analysis: This protocol strictly follows the development process outlined in the WHO Handbook for Guideline Development and Guidelines 2.
Am J Respir Crit Care Med
January 2025
University of Medicine and Pharmacy Carol Davila Bucharest, Bucuresti, Romania.
Rationale: Early detection, standardized therapy, adequate infrastructure and strategies for quality improvement should constitute essential components of every hospital's sepsis plan.
Objectives: To investigate the extent to which recommendations from the sepsis guidelines are implemented and the availability of infrastructure for the care of patients with sepsis in acute hospitals.
Methods: A multidisciplinary cross-sectional questionnaire was used to investigate sepsis care in hospitals.
Prehosp Emerg Care
January 2025
Department of Emergency Medicine, Oregon Health & Science University, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd Portland, OR 97239.
Objectives: Out-of-hospital births are associated with a 2-to 11-fold increased risk of death compared to in-hospital births and are growing. Emergency Medical Services (EMS) clinicians have limited exposure to hospital birth emergencies, and there is no standardized prehospital neonatal resuscitation curriculum. Neonatal Resuscitation Program (NRP) guidelines are the standard of care for infants born in the United States but focuses on in-hospital births and is not easily applied to EMS.
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