ABSTRACT
OBJECTIVES: To adapt the adult Comprehensive Severity Index (CSI) for hospitalized pediatric patients and evaluate the ability of the CSI to predict common outcomes. STUDY DESIGN: Adult CSI was modified by a panel of pediatric subspecialists from 10 children's hospitals. Predictive power was evaluated by using retrospective data collected from 16,495 randomly selected children admitted to these hospitals from April 1995 through September 1996. Outcomes were mortality, length of stay (LOS), and cost. RESULTS: Admission CSI score predicted mortality well (Hosmer-Lemeshow tests: P =.41-.98) and discriminated well (area under receiver operating characteristic [ROC] curve range = 0.80-0.99) within 9 case-mix groups with > or =10 deaths (P <.0001). Maximum CSI score explained the variation in LOS (r2 = 0.13-0.67) and cost (r2 = 0.08-0.73) within 32 case-mix groups (P <.005). Significant differences existed in admission and maximum average CSI scores across sites in 26 and 29 of 32 case-mix groups, respectively (P <.05). CSI had better predictability than Pediatric Risk of Mortality. CONCLUSIONS: The age- and disease-specific pediatric CSI score correlates highly with LOS, cost, and mortality in hospitalized children and can help determine the best clinical practices for specific diseases and adjust for differences in severity of illness across providers.
Subject(s)
Disease , Severity of Illness Index , Adolescent , Adult , Age Factors , Child , Child Welfare , Child, Preschool , Diagnosis-Related Groups , Disease/economics , Female , Health Care Costs , Humans , Infant , Infant, Newborn , Length of Stay/economics , Male , Patient Admission/economics , Predictive Value of Tests , Sensitivity and Specificity , Survival Analysis , United States/epidemiologyABSTRACT
Se realizan radiografías periapicales por el método de bisección a 47 pacientes que presentaban un total de 61 dientes con tratamientos pulporradiculares realizados con 3 o más años de antelación, con el fin de conocer la efectividad de los mismos y las principales causas que pudieran incidir en los tratamientos fracasados. Se detectaron 13 tratamientos fracasados, lo que representa el 21,3 por ciento de la muestra; además, el 42,6 por ciento de los conductos se encontraban instrumentados parcialmente; esto constituyó la principal causa de fracasos. En sentido general, no se encontraron diferencias apreciables en cuanto a las principales causas expresadas por otros autores