RESUMO
OBJECTIVE: To evaluate the validity of the Responses to Illness Severity Quantification (RISQ) score to discriminate illness severity and transitions between levels of care during hospitalization. STUDY DESIGN: A prospective observational study conducted in Maiduguri, Nigeria, enrolled inpatients aged 1-59 months with severe acute malnutrition. The primary outcome was the RISQ score associated with the patient state. Heart and respiratory rate, oxygen saturation, respiratory effort, oxygen use, temperature, and level of consciousness are summed to calculate the RISQ score. Five states were defined by levels of care and hospital discharge outcome. The states were classified hierarchically, reflecting illness severity: hospital mortality was the most severe state, then intensive care unit (ICU), care in the stabilization phase (SP), care in the rehabilitation phase (RP), and lowest severity, survival at hospital discharge. A multistate statistical model examined performance of the RISQ score in predicting clinical states and transitions. RESULTS: Of 903 children enrolled (mean age, 14.6 months), 63 (7%) died. Mean RISQ scores during care in each phase were 3.5 (n = 2265) in the ICU, 1.7 (n = 6301) in the SP, and 1.5 (n = 2377) in the RP. Mean scores and HRs for a 3-point change in score at transitions: ICU to death, 6.9 (HR, 1.80); SP to ICU, 2.8 (HR, 2.00); ICU to SP, 2.0 (HR, 0.5); and RP to discharge, 1.4 (HR, 0.91). CONCLUSIONS: The RISQ score can discriminate between points of escalation or de-escalation of care and reflects illness severity in hospitalized children with severe acute malnutrition. Evaluation of clinical implementation and demonstration of benefit will be important before widespread adoption.
Assuntos
Criança Hospitalizada , Desnutrição Aguda Grave , Criança , Humanos , Lactente , Transferência de Pacientes , Nigéria , Unidades de Terapia Intensiva , Índice de Gravidade de Doença , Gravidade do Paciente , Desnutrição Aguda Grave/diagnóstico , Desnutrição Aguda Grave/terapiaRESUMO
Se evaluó el poder predictivo de la circunferencia media de brazo para la identificación precoz de desnutrición aguda en niños preescolares y escolares hospitalizados en dos hospitales de Valencia, estado Carabobo. Se evaluaron 182 niños entre 2-10 años. Estado nutricional antropométrico calculado por: circunferencia media del brazo para la edad CMB y peso para la talla P/T. Se empleó paquete estadístico SPSS versión 15.0 y Statistix versión 6.0. Se determinó sensibilidad, especificidad, valor predictivo positivo y negativo por Teorema de Bayes; correspondencia por índice Kappa; diagnóstico de desnutrición aguda y sensibilidad por CMB y área bajo la curva ROC; nivel de confianza 95%. Se encontró 51,1% masculinos, 48,9% femeninos, edad 5,2 ± 2,2 años; 71,4% pre-escolares, 28,6% escolares con p=0,000 entre las edades. Cuando se ajustó por sexo y edad, la CMB se correlacionó significativamente con el peso (r=0,804; p=0,000) y la talla (r=0,510; p=0,000). Índice Kappa de 0,720 (p=0,000) para la comparación entre P/T y CMB en el diagnóstico de desnutrición aguda. Prevalencia de 28% por desnutrición aguda para P/T y 34,6% para CMB, con concordancia entre ambos indicadores. CMB presentó buena sensibilidad y especificidad, siendo más sensible y específica en pre-escolares y escolares masculinos para niños con desnutrición aguda. Punto de corte para desnutrición aguda en preescolares 14,9 cm, con sensibilidad 85,5%; especificidad 74,5%; para escolares 16,0 cm con sensibilidad 89,2%; especificidad 80%. CMB demostró mejor predictor de desnutrición aguda que P/T. Se recomienda establecer puntos de corte específicos por edad y sexo, para la definición y clasificación del déficit nutricional(AU)
The predictive power of the middle arm circumference for early identification of acute malnutrition in preschool and school children hospitalized in two hospitals in Valencia, Carabobo state. Was evaluated 182 children aged 2-10 years were evaluated. Anthropometric nutritional status calculated by: mid-arm circumference for age MAC and weight for height P/T. SPSS version 15.0 and Statistix version 6.0 was used. Sensitivity, specificity, positive and negative predictive value was determined by Bayes Theorem; Kappa index for correspondence; Diagnosis of acute malnutrition and sensitivity by MAC and area under the curve ROC; 95% confidence level. We found 51.1% male, 48.9% female, age 5.2 ± 2.2 years; 71.4% pre-school, school 28.6% (p = 0.000) between ages. When adjusted for sex and age, the CMB was significantly correlated with weight (r = 0.804; p = 0.000) and height (r = 0.510; p = 0.000). Kappa index of 0.720 (p = 0.000) for the comparison between P/T and CMB in the diagnosis of acute malnutrition. Acute malnutrition 28% prevalence for P/T and 34.6% for MAC, with agreement between both indicators. MAC showed good sensitivity and specificity, being more sensitive and specific in pre-school and school male children with acute malnutrition. 14.9 cm of cutoff point for acute malnutrition in preschool, with 85.5% sensitivity; 74.5% specificity; for school 16 cm with 89.2% sensitivity; 80% specificity. MAC showed better predictor of acute malnutrition P/T. It is recommended to set specific cutoffs for age and sex, for the definition and classification of nutritional deficit(AU)