Abstract
Objectives
To evaluate the performance of the empiric tool by Gupta et al. in predicting neurological outcomes in children admitted to the pediatric intensive care unit (PICU) and to evaluate the association of biomarkers S100B and NSE with neurological outcomes.
Methods
This prospective observational study was conducted in 163 critically ill children aged 2 mo to 17 y admitted to the PICU from June 2020 to July 2021. The authors used the prediction tool developed by Gupta et al.; the tool was applied at admission and at PICU discharge/death. Samples for NSE and S100B were collected at admission and discharge. The performance of the new tool was assessed through discrimination and calibration. Risk factors for “unfavorable outcomes” (decline in PCPC score by > 1) were evaluated by multivariate analysis.
Results
The PICU mortality was 28% (n = 45). When the tool developed by Gupta et al. was used at the time of admission, favorable neurological outcomes were predicted for 69% (112) children. The area under the curve for the new tool at admission was 0.72 and at discharge/death it was 0.99, and the calibration was excellent at both time points. Independent factors associated with unfavorable neurological outcomes were higher PCPC scores and organ failure. As the number of samples processed for NSE and S100B was less, statistical analysis was not attempted.
Conclusions
The new tool by Gupta et al. has good discrimination, calibration, sensitivity, and specificity and can be used as a prediction tool. NSE and S100B are promising biomarkers and need further evaluation.
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Acknowledgements
The authors would like to sincerely acknowledge the contribution of the Indian Journal of Pediatrics for providing the logistics to estimate the NSE and S-100B markers in the study. The authors would like to sincerely thank the contributions of the residents and the staff posted at the ICU during the study period.
Funding
Kumar Himanshu Bhadani received the Indian Journal of Pediatrics, Post Graduate thesis grant for the year 2020–21 for the thesis work.
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KHB, JS, and SKD contributed with conception of work, acquisition, analysis, and interpretation of data, and drafting the work; ST, RL, SKK, KRJ contributed with conception of work, interpretation of data, and revising the work. All authors have approved the final version and agreed to accountability for accuracy of work. SKK will act as the guarantor for this paper.
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The AIIMS, Institute Ethics Committee reviewed and approved the study and the approval number is IECPG-681/19.12.2019.
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Bhadani, K.H., Sankar, J., Datta, S.K. et al. Validation of a Clinical Tool to Predict Neurological Outcomes in Critically Ill Children—A Prospective Observational Study. Indian J Pediatr 91, 10–16 (2024). https://doi.org/10.1007/s12098-023-04482-3
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DOI: https://doi.org/10.1007/s12098-023-04482-3