சுருக்கம்

Effectiveness of admission TOPRS score in predicting the outcome in pediatric inpatients - A prospective observational multicentric study.

Krithika AP*, Sasikumar BR, Senthil Kumar M, Sundari S

Introduction: Identification and triage of seriously ill patients visiting emergency department is very important for prioritization of care. One of the key tasks in both hospital ER and primary-care settings is therefore, to distinguish children who may have serious infections (e.g., meningitis, bacteremia) or complications from infection (e.g., hypoxia from bronchiolitis, dehydration from gastroenteritis) from the vast majority with self-limiting or minor infections that can be safely managed at home. A simple and effective scoring system using clinical variables can help in guiding through the process of triage. TOPRS score consists of simple clinical variables and can even be done by a paramedic. TOPRS stands for: • T-Temperature • O-Oxygen saturation • P-Pulse rate • R -Respiratory rate • S-Seizure In our study, scoring system, TOPRS uses only vital signs to predict the severity of illness and mortality in pediatric emergency department was evaluated, as a multicentric study, to see if it is applicable and reliable in the existing setup in Coimbatore medical college and hospital, government medical college and hospital, Tiruppur and Sree Balaji medical college and hospital, Chennai. Aims and objectives of study: To identify sick children in a busy pediatric outpatient department in a tertiary care hospital by using a simple scoring system. (TOPRS) Secondary objective: To ensure timely and appropriate treatment in a resource poor setting. Material and methods: Children admitted in pediatric wards and PICU at Coimbatore medical college and hospital, government medical college and hospital, Tiruppur and Sree Balaji medical college and hospital, Chennai from March 2021 to January 2022. Type of study: Prospective observational multicentric study. Inclusion criteria: Infants from 1month to 1 year and children aged 1 year to 12 years admitted in pediatric ward and PICU Results and observation: This study was conducted in Coimbatore medical college and hospital, government medical college and hospital, Tiruppur and Sree Balaji medical college and hospital, Chennai, by enrolling 600 children after getting ethical committee clearance. The predictive ability of the test was arrived at, by using the Receiver Operating Curve (ROC). The distribution of each variable in the study population was analyzed and the association between each of these variables to the outcome was also analyzed. The association between the final score and outcome was analyzed using the receiver operating curve. This study included study group with the mean age of 4.87 years. The distribution of boys was greater than that of girls in this study. Boys 51.8%; Girls 48.2%. There was a statistically significant correlation between temperature abnormality, oxygen saturation, pulse rate, respiratory rate and seizures and the adverse outcome.

Conclusion: The TOPRS score is a simple scoring system using simple clinical variables and does not require expertise to perform. This study has shown a definite correlation between the TOPRS score and the poor outcome. It has also revealed that, higher the score, longer the ICU stays. Among the variables, the temperature and the heart rate abnormality were associated with poorer outcomes in comparison to the other variables.