Reliability and validity of the Pediatric Intensity Level of Therapy (PILOT) scale: A measure of the use of intracranial pressure–directed therapies.
In: Critical Care Medicine, Jg. 34 (2006-07-01), Heft 7, S. 1981-1987
Online
academicJournal
Zugriff:
OBJECTIVE:: To test the reliability and validity of the Pediatric Intensity Level of Therapy (PILOT) scale, a novel measure of overall therapeutic effort directed at controlling intracranial pressure (ICP) in the setting of severe (Glasgow Coma Scale of ≤ 8) pediatric traumatic brain injury (TBI).DESIGN:: Case-control study via retrospective review of medical records.SETTING:: Tertiary-care, university-based children’s hospital intensive care unit.PATIENTS:: Randomly selected patients ≤18 yrs old admitted to the intensive care unit in 2002–2003 with severe TBI (cases: group 1, n = 27), mild–moderate TBI (control: group 2, n = 30), extracranial trauma (control: group 3, n = 29), or nontraumatic illnesses (control: group 4, n = 27).INTERVENTIONS:: None.MEASUREMENTS AND MAIN RESULTS:: A 38-point scale was developed to quantify daily ICP-directed therapeutic effort. All currently recommended therapies are represented. Demographic and physiologic data were collected on all patients. A total of 24 of 27 patients with severe TBI received ICP-directed therapy; three did not because of judgments of futility. No control patients received ICP-directed therapy. The PILOT scale score was assessed for the first 7 days posttrauma or postadmission. Interrater reliability was 0.91 (intraclass correlation coefficient) and intrarater reliability was 0.94. The highest PILOT scale scores were in patients with severe TBI (11.7 ± 5.6 vs. 1.3 ± 1.7 vs. 2.0 ± 2.1 vs. 1.9 ± 1.8 for groups 1, 2, 3 and 4, respectively [mean ± sd]; p < .001 by analysis of variance/Bonferroni). Patients with severe TBI who received ICP-directed therapy had higher PILOT scale scores (12.6 ± 5.3 vs. 5.0 ± 3.0, p = .001) than those who did not. Pearson’s correlation coefficients of mean PILOT scale scores with measures of injury severity, outcome, and ICP were as follows: Glasgow Coma Scales score, −0.73 (p < .001); overall Injury Severity Score, 0.37 (p < .001); Injury Severity Score (head component only), 0.53 (p < .001); 6-month Glasgow Outcome Scale, −0.26 (p = .006); ICP burden (hours per day with ICP above treatment threshold), 0.59 (p = .002); and mean ICP, 0.41 (p = .044).CONCLUSIONS:: The PILOT scale score can be obtained retrospectively and has good reliability. It can discriminate patients receiving ICP-directed therapy, even among patients with severe TBI, and correlates with measures of injury severity, outcome, and ICP in an expected way. Thus, it seems to be a valid measure of the use of ICP-directed therapy, although prospective, multiple-center validation is recommended. [ABSTRACT FROM AUTHOR]
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Reliability and validity of the Pediatric Intensity Level of Therapy (PILOT) scale: A measure of the use of intracranial pressure–directed therapies.
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Autor/in / Beteiligte Person: | Shore, Paul |
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Zeitschrift: | Critical Care Medicine, Jg. 34 (2006-07-01), Heft 7, S. 1981-1987 |
Veröffentlichung: | 2006 |
Medientyp: | academicJournal |
ISSN: | 0090-3493 (print) |
DOI: | 10.1097/01.CCM.0000220765.22184.ED |
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