Validation of the Signs of Inflammation in Children that can Kill (SICK) score for assessment of illness severity
Keywords:
SICK score, risk of mortality, severity of illness, non-invasive assessment
Abstract
Background The Signs of Inflammation in Children that can Kill(SICK) score has been developed in the search for a practical
triage tool in settings with limited resources for immediate, noninvasive
assessment of illness severity. Its seven parameters are
heart rate, respiratory rate, systolic blood pressure, temperature,
blood oxygen saturation (Sp02), capillary refill time (CRT), and
level of consciousness. The SICK score also takes into account
the age of the child.
Objective To assess the validity of SICK scores for differentiating
between high and low probabilities of death in children.
Methods We performed a prospective evaluation of all children
aged between one month to twelve years admitted to the Pediatric
Emergency Care Unit at Prof. Dr. R.D. Kandou Hospital, Manado
between October 2011 to January 2012. We calculated SICK
scores at the time of presentation and assessed their correlation
with subsequent in-hospital mortality using logis tic regression
analysis.
Results During the study period, we observed 230 patients,
of whom 199 survived and 31 died. There were 134 males, of
whom 117 survived and 17 died. The remaining 96 subjects were
female, of whom 82 survived and 14 died. Logistic regression
analysis revealed a significant relationship between SICK score
and mortality (P< 0.001). With a probability of 0.5, we attained
a cut off score of 4.74 points, with 96.8% sensitivity and 99.5%
specificity for the prediction of mortality.
Conclusion T he high SICK score is associated with higher
probability of death. A cut off score of 4. 74 has high sensitivity and
specificity for predicting the probability of death. The SICK score
may be useful as a triage tool at the patient's initial presentation,
particularly in settings with limited resources.
References
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11. Puliyel JM. SICK score calculator [homepage on the
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12. Bhal S, Tygai V, Kumar N, Sreenivas V, Puliyel JM. Signs
of inflammation in children that can kill (SICK score):
preliminary prospective validation of a new non-invasive
measure of severity-of-illness. J Postgrad Med. 2006;52:102-
5.
score system for detecting critical illness. Clin Intensive Care.
1997 ;8: 100.
2. Sub be CP, Kruger M, Rutherford P, Gemmel L. Validation of
a modified Early Warning Score in medical admissions. QJ
Med. 2001;94:521-6.
308 • Paediatr Irulones, Vol. 53, No. 6, November 2013
3. Yeh TS, Pollack MM, Ruttimann UE, Holbrook PR, Fields A.
Validation of a physiologic stability index for use in critically
ill infants and children. Pediatric Res. 1984; 18:445-51.
4. Pollack MM, Ruttimann UE, Getson PR. The pediatric risk of
mortality (PRISM) score. Crit Care Med. 1988;16: 1110-6.
5. Slater A, Shann F, Pearson G, Pediatric Index of Mortality
(PIM) Study Group. PIM2: a revised version of the Pediatric
Index of Mortality. Intensive Care Med. 2003;29:278-85.
6. Thompson MJ, Coad N, Hamden A, Mayon-White R, Perera
R, Mant D. How well do vital signs identify children with
serious infections in paediatric emergency care? Arch Dis
Child. 2009;94:888-93.
7. Sun D, Aikawa N. The natural history of the systemic
inflammatory response syndrome and the evaluation of SIRS
criteria as a predictor of severity in patients hospitalized
through emergency services. Keio J Med. 1999;48:28-3 7.
8. Kumar N, Thomas N, Singha! D, Puliyel JM, Sreenivas
V. Triage score for severity of illness. Indian Pediatr.
2003 ;40:204-10.
9. Lemeshow S, Le Gall JR. Modeling the severity of illness
of IW patients: a systems update. JAMA. 1994;272:1049-
55.
10. Gupta AM, Chakrabarty A, Halstead R, Sahni M, Rangasami
J, Puliyel A, et al. Validation of "signs of inflammation in
children that kill" (SICK) score for immediate non-invasive
assessment of severity of illness. Ital J Pediatr. 2010;36:35-
40.
11. Puliyel JM. SICK score calculator [homepage on the
Internet]. Free Software Foundation; [cited 2013 May 15].
Available from: http:/i'.Jacob .puliyel.com/sick.php.
12. Bhal S, Tygai V, Kumar N, Sreenivas V, Puliyel JM. Signs
of inflammation in children that can kill (SICK score):
preliminary prospective validation of a new non-invasive
measure of severity-of-illness. J Postgrad Med. 2006;52:102-
5.
Published
2013-12-30
How to Cite
1.
Mandei J, Runtunuwu A, Daryanani C. Validation of the Signs of Inflammation in Children that can Kill (SICK) score for assessment of illness severity. PI [Internet]. 30Dec.2013 [cited 22Dec.2024];53(6):305-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/312
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Received 2016-08-21
Accepted 2016-08-21
Published 2013-12-30
Accepted 2016-08-21
Published 2013-12-30
