Abstract
BackgroundTo study mean core to peripheral temperature difference (CPTD) and the mean lactate levels over the first 6 h of admission to hospital, as indicators of prognosis in critically ill children.MethodsA prospective observational study in a tertiary level Pediatrics ICU in Delhi, India. Seventy eight paediatric patients from 1 month to 12 years were studied. Children with physical trauma, post-surgical patients and patients with peripheral vascular disease were excluded. Core temperature (skin over temporal artery) to peripheral temperature (big toe) difference was measured repeatedly every minute over 6 h and mean of temperature difference was calculated. Pediatric Risk of Mortality (PRISM) II, lactate clearance and mean lactate levels during that time were also studied. In-hospital mortality was used as the outcome measure.ResultsMean temperature differenceDuring the first 6 h after admission the mean temperature difference was 9.37 ± 2 °C in those who died and 3.71 ± 2.27 °C in those who survived (p < 0.0001). The area under the receiver operating curve (AUROC) was 0.953 (p < 0.0001). The comparable AUROC of PRISM II was 0.999 (p < 0.0001).Mean LactateMean lactate level in the first 6 h was 7.1 ± 2.02 mg/dl in those who died compared to 2.86 ± 0.87 mg/dl in those who survived (p < 0.0001). The AUROC curve for mean lactate was 0.989 (95% CI = 0.933 to 0.999; p < 0.0001). AUROC for the lactate clearance was 0.682 (p = 0.0214).ConclusionsThe mean core to peripheral temperature difference over the first 6 h is an easy-to-use and non-invasive method that is useful to predict mortality in children admitted to the Pediatric ICU. The mean lactate during the first 6 h of Pediatric ICU admission is a better index of prognosis than the lactate clearance over the same time period. They may be used as components of a scoring system to predict mortality.
Highlights
To study mean core to peripheral temperature difference (CPTD) and the mean lactate levels over the first 6 h of admission to hospital, as indicators of prognosis in critically ill children
We studied the prediction of mortality using continuously recorded core to peripheral temperature difference (CPTD), against other indicators of prognosis, namely Pediatric Risk of Mortality (PRISM) score [22] and lactate clearance during the first 6 h of hospital admission (defined as the percentage decrease in lactate [(lactateinitial – lactateafter 6 h) / lactateinitial × 100 [15]
We anticipate that the prognosis prediction would be better using PRISM III than it is with PRISM II but the scope for improvement in our sample is likely to be marginal, given the area under the receiver operating curve (AUROC) of 0.999 with PRISM II
Summary
To study mean core to peripheral temperature difference (CPTD) and the mean lactate levels over the first 6 h of admission to hospital, as indicators of prognosis in critically ill children. Skin temperature can be used as an index of perfusion and it is influenced by the cardiac output and the tone of the arteriolar vessels [2]. Schey and colleagues have used the core to peripheral temperature difference as a marker of perfusion and hemodynamic stability in critically ill patients [4]. Peripheral skin temperature has been found to be a better predictor of in-hospital mortality than the mean arterial blood pressure [5,6,7]. The core to peripheral temperature difference has been validated in paediatric patients as a predictor of mortality [2, 8, 9]
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