Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/33595
Title: A Clinical Score for Quantifying Edema in Mechanically Ventilated Children With Congenital Heart Disease in Intensive Care.
Austin Authors: Gelbart, Ben;Kapalavai, Sudeep Kumar;Marchesini, Vanessa;Presneill, Jeffrey;Veysey, Andrea;Serratore, Alyssa;Appleyard, Jessica;Bellomo, Rinaldo ;Butt, Warwick;Duke, Trevor
Affiliation: Paediatric Intensive Care Unit, University of Melbourne, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia.
Paediatric Intensive Care Unit, The Royal Children's Hospital, Parkville, VIC, Australia.
Paediatric Intensive Care Unit, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia.
Department of Intensive Care, Royal Melbourne Hospital, Parkville, VIC, Australia.;Department of Critical Care, University of Melbourne, Parkville, VIC, Australia.
Paediatric Intensive Care Unit, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia.
Intensive Care
Data Analytics Research and Evaluation (DARE) Centre
Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.;Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.;Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Issue Date: Jun-2023
Date: 2023
Publication information: Critical Care Explorations 2023-06; 5(6)
Abstract: Standardized clinical measurements of edema do not exist. To describe a 19-point clinical edema score (CES), investigate its interobserver agreement, and compare changes between such CES and body weight. Prospective observational study in a tertiary PICU of mechanically ventilated children with congenital heart disease. Differences in the median CES between observer groups. We studied 61 children, with a median age of 8.0 days (interquartile range, 1.0-14.0 d). A total of 539 CES were performed by three observer groups (medical 1 [reference], medical 2, and bedside nurse) at 0, 24, and 48 hours from enrollment. Overall, there was close agreement between observer groups in mean, median, and upper quartile of CES scores, with least agreement observed in the lower quartile of scores. Across all quartiles of CES, after adjusting for baseline weight, cardiac surgical risk, duration of cardiopulmonary bypass, or peritoneal dialysis during the study, observer groups returned similar mean scores (medical 2: 25th centile +0.1 [95% CI, -0.2 to 0.5], median +0.6 [95% CI, -0.4 to 1.5], 75th centile +0.1 [95% CI, -1.1 to 1.4] and nurse: 25th centile +0.5 [95% CI, 0.0-0.9], median +0.7 [95% CI, 0.0-1.5], 75th centile -0.2 [95% CI, -1.3 to 1.0]) Within a multivariable mixed-effects linear regression model, including adjustment for baseline CES, each 1 point increase in CES was associated with a 12.1 grams (95% CI, 3.2-21 grams) increase in body weight. In mechanically ventilated children with congenital heart disease, three groups of observers tended to agree when assessing overall edema using an ordinal clinical score assessed in six body regions, with agreement least at low edema scores. An increase in CES was associated with an increase in body weight, suggesting some validity for quantifying edema. Further exploration of the CES as a rapid clinical tool is indicated.
URI: https://ahro.austin.org.au/austinjspui/handle/1/33595
DOI: 10.1097/CCE.0000000000000924
ORCID: 
Journal: Critical Care Explorations
Start page: e0924
PubMed URL: 37637355
ISSN: 2639-8028
Type: Journal Article
Subjects: clinical score
edema
fluid overload
pediatric intensive care
Appears in Collections:Journal articles

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