@article{ref1,
title="Prospective evaluation of a clinical decision tool to reduce childhood admissions to PICUs for poisoning: ReCAP",
journal="Clinical toxicology (Philadelphia, Pa.)",
year="2019",
author="Grunwell, Jocelyn R. and McCracken, Courtney E. and Travers, Curtis D. and Geller, Robert J. and Kamat, Pradip P.",
volume="ePub",
number="ePub",
pages="1-5",
abstract="AIM: To prospectively validate a pediatric clinical prediction model to identify children at low risk of clinically significant ingestions to prevent unnecessary pediatric intensive care unit (PICU) admissions. <br><br>METHODS: Calls received by the Georgia Poison Center about children for acute ingestions between May 25, 2017 and May 17, 2018 were scored in real time using the full, age-stratified, and simplified clinical scoring tool to reduce childhood admissions to PICUs for poisoning (RECAP<sup>2</sup>). Clinically significant ingestions with a poison center recommendation of PICU admission are defined in the simple RECAP<sup>2</sup> model as ingestion of clonidine, ethanol, an oral anti-hyperglycemic agent, or exposure to carbon monoxide, as well as the presence of symptoms occurring within 2 h for an immediate release, or 4 h for an extended release, medication exposure. Model statistics and percent reduction in PICU admissions were computed. <br><br>RESULTS: There were 886 children admitted after ingestions, of which 454 (51.2%) children were admitted to intensive care. At the time of the initial poison center call to report the ingestion, 44 cases (5%) were incomplete using the full, age-stratified model compared to the complete scoring using the simple scoring model. Seventy-two children (8.1%) required monitoring or interventions performed only in a PICU. Real-time application of the full model compared with the simple model would have reduced PICU admissions by 33.3 and 31.7%, respectively. <br><br>CONCLUSIONS: The simple RECAP<sup>2</sup> clinical scoring model is a sensitive prediction tool to identify children at very low risk for clinically significant ingestions for whom PICU admission can be avoided. Clinical implementation of the simple RECAP<sup>2</sup> model and recommendation for admission to an inpatient unit versus PICU should be further evaluated, to reduce unnecessary PICU admissions following acute ingestions.<p /> <p>Language: en</p>",
language="en",
issn="1556-3650",
doi="10.1080/15563650.2019.1590587",
url="http://dx.doi.org/10.1080/15563650.2019.1590587"
}