A Simple Clinical Score “TOPRS” to Predict Outcome in Pediatric Emergency Department in a Teaching Hospital in India|
Bains, Harmesh S. & Soni, Ravinder Kumar
Objective: To develop a simple clinical scoring system for severity of illness to help prioritize care and predict
outcome in emergency department.
Methods: Prospective hospital based observational study. Out of a total of 874 children who attended
emergency department in one year, 777 were included in the study. Data was collected at the time of
admission in emergency department. The baseline information like age, gender, etc and variables of ‘toprs’
score viz temperature, oxygen saturation, pulse rate, respiratory rate, sensorium and seizures were recorded.
Variables were categorized as normal (score zero) or abnormal (score 1) based on systemic inflammatory
response syndrome (SIRS) criteria and criteria mentioned in advanced pediatric life support (APLS) and the
total scores were computed for each child. The outcome (death/discharge) was correlated with the study
variables and total score. The predictive ability of score was calculated using receiver operating characteristic
(ROC) curve analysis.
Findings: Of the six variables, temperature, oxygen saturation and respiratory rate were found to be
significantly associated with mortality. Mortality increased with the increase in the number of abnormal
variables. Based on the regression coefficients, maximum possible score was 6.68. The predictive ability of
score was 81.7 calculated using ROC curve. Maximum discrimination was observed at a score of 2.5.
Conclusion: For triage in emergency, any patient with 2 or more abnormal variables should be closely
monitored and evaluated. These patients require admission as they have a potential risk of death.
Outcome Assessment; Triage; Emergency Room; Pediatrics