- Pediatrics
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Multicenter validation of a deep-learning-based pediatric early-warning system for prediction of deterioration events
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Yunseob Shin, Kyung-Jae Cho, Yeha Lee, Yu Hyeon Choi, Jae Hwa Jung, Soo Yeon Kim, Yeo Hyang Kim, Young A Kim, Joongbum Cho, Seong Jong Park, Won Kyoung Jhang
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Acute Crit Care. 2022;37(4):654-666. Published online October 26, 2022
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DOI: https://doi.org/10.4266/acc.2022.00976
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- Background
Early recognition of deterioration events is crucial to improve clinical outcomes. For this purpose, we developed a deep-learning-based pediatric early-warning system (pDEWS) and aimed to validate its clinical performance. Methods: This is a retrospective multicenter cohort study including five tertiary-care academic children’s hospitals. All pediatric patients younger than 19 years admitted to the general ward from January 2019 to December 2019 were included. Using patient electronic medical records, we evaluated the clinical performance of the pDEWS for identifying deterioration events defined as in-hospital cardiac arrest (IHCA) and unexpected general ward-to-pediatric intensive care unit transfer (UIT) within 24 hours before event occurrence. We also compared pDEWS performance to those of the modified pediatric early-warning score (PEWS) and prediction models using logistic regression (LR) and random forest (RF). Results: The study population consisted of 28,758 patients with 34 cases of IHCA and 291 cases of UIT. pDEWS showed better performance for predicting deterioration events with a larger area under the receiver operating characteristic curve, fewer false alarms, a lower mean alarm count per day, and a smaller number of cases needed to examine than the modified PEWS, LR, or RF models regardless of site, event occurrence time, age group, or sex. Conclusions: The pDEWS outperformed modified PEWS, LR, and RF models for early and accurate prediction of deterioration events regardless of clinical situation. This study demonstrated the potential of pDEWS as an efficient screening tool for efferent operation of rapid response teams.
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Citations
Citations to this article as recorded by
- Predicting cardiac arrest after neonatal cardiac surgery
Alexis L. Benscoter, Mark A. Law, Santiago Borasino, A. K. M. Fazlur Rahman, Jeffrey A. Alten, Mihir R. Atreya Intensive Care Medicine – Paediatric and Neonatal.2024;[Epub] CrossRef - Volumetric regional MRI and neuropsychological predictors of motor task variability in cognitively unimpaired, Mild Cognitive Impairment, and probable Alzheimer's disease older adults
Michael Malek-Ahmadi, Kevin Duff, Kewei Chen, Yi Su, Jace B. King, Vincent Koppelmans, Sydney Y. Schaefer Experimental Gerontology.2023; 173: 112087. CrossRef - Predicting sepsis using deep learning across international sites: a retrospective development and validation study
Michael Moor, Nicolas Bennett, Drago Plečko, Max Horn, Bastian Rieck, Nicolai Meinshausen, Peter Bühlmann, Karsten Borgwardt eClinicalMedicine.2023; 62: 102124. CrossRef - A model study for the classification of high-risk groups for cardiac arrest in general ward patients using simulation techniques
Seok Young Song, Won-Kee Choi, Sanggyu Kwak Medicine.2023; 102(37): e35057. CrossRef - An advanced pediatric early warning system: a reliable sentinel, not annoying extra work
Young Joo Han Acute and Critical Care.2022; 37(4): 667. CrossRef
- Infection
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A successful application of adult polymyxin B-immobilized fiber column hemoperfusion to a neonate with septic shock
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Young A Kim, Hyungtae Kim, Yu-Mi Kim, Su Eun Park
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Acute Crit Care. 2019;34(4):284-288. Published online November 6, 2018
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DOI: https://doi.org/10.4266/acc.2017.00528
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Correction in: Acute Crit Care 2023;38(4):515
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29,472
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- Direct hemoperfusion therapy with a polymyxin B-immobilized fiber column (PMX-HP) has been introduced as a therapeutic option for gram negative bacterial septic shock in adults. However, its use in neonates and children has not yet been established. We successfully performed hemoperfusion therapy using an adult polymyxin B-immobilized fiber column in a neonate with carbapenem resistant Acinetobacter baumannii septic shock. The application was technically feasible because the neonate was on extracorporeal membrane oxygenation (ECMO). Although it did not rescue the patient, there was significant short-lasting improvement in pulmonary oxygenation and hemodynamics, leading to wean the patient from ECMO. PMX-HP could be used as an adjunctive treatment for selected neonatal and pediatric patients with gram negative bacterial septic shock.
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Citations
Citations to this article as recorded by
- Polymyxin B Hemoperfusion in Pediatric Septic Shock: Single-Center Observational Case Series
Patcharin Saetang, Rujipat Samransamruajkit, Kanokwan Singjam, Tawatchai Deekajorndech Pediatric Critical Care Medicine.2022; 23(8): e386. CrossRef - Controlling an Outbreak of Multidrug-resistant Acinetobacter baumannii in a Pediatric Intensive Care Unit: a Retrospective Analysis
Joung-Hee Byun, Su Eun Park, Minhae Seo, Jeungmi Jang, Mi Sun Hwang, Ju Yeoun Song, Chulhun L. Chang, Young A Kim Journal of Korean Medical Science.2021;[Epub] CrossRef - Effects of continuous renal replacement therapy with the AN69ST membrane for septic shock and sepsis-induced AKI in an infant: a case report with literature review of cytokine/mediator removal therapy in children
Naoto Nishizaki, Riko Ueno, Yuki Nagayama, Hanako Abe, Akina Matsuda, Akira Mizutani, Kaoru Obinata, Tadaharu Okazaki, Toshiaki Shimizu Renal Replacement Therapy.2020;[Epub] CrossRef - Suggestions and tips regarding polymyxin B-immobilized fiber column direct hemoperfusion of neonates with sepsis
Naoto Nishizaki Acute and Critical Care.2020; 35(3): 226. CrossRef - Case Report: Successful Use of Extracorporeal Therapies After ECMO Resuscitation in a Pediatric Kidney Transplant Recipient
Andrey Rybalko, Anna Pytal, Mikhail Kaabak, Nadejda Rappoport, Anuar Bidzhiev, Vasilii Lastovka Frontiers in Pediatrics.2020;[Epub] CrossRef
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