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Biomedical subjects

Frank Shann

Publications and source records attributed to Frank Shann.

7 recordsLinked to original sources
PubMed2003

The ANZPIC registry diagnostic codes: a system for coding reasons for admitting children to intensive care.

OBJECTIVE: To describe the uniform diagnostic coding system used in Australia and New Zealand to code reasons for admitting children to intensive care, and to highlight the benefits of a uniform approach. DESIGN: International, multicentre, observational study. SETTING: A registry of children admitted to intensive care in Australia and New Zealand. PATIENTS: The records of 19249 children admitted to intensive care between 1997 and 2000 were analysed. MEASUREMENTS AND RESULTS: The system was designed empirically using expert consensus. The principal diagnosis or main reason for intensive care admission and up to five associated diagnoses are coded. The system has four levels of coding: non-operative or post-procedural admission, diagnostic group, specific condition, and for injury and infection the aetiological factor. The main reason for intensive care admission was coded in all patient records, however, for 11.1% of records the code was limited to diagnostic group with the specific condition coded as "other diagnosis". Two or more diagnoses were coded in 61% of records. The most frequent reason for admission was asthma. CONCLUSIONS: The major advantage of the system is that units in the region use the same method of coding. A uniform international approach to coding reasons for admitting children to intensive care is needed.

Australia↗
PubMed2003

PIM2: a revised version of the Paediatric Index of Mortality.

OBJECTIVE: To revise the Paediatric Index of Mortality (PIM) to adjust for improvement in the outcome of paediatric intensive care. DESIGN: International, multi-centre, prospective, observational study. SETTING: Twelve specialist paediatric intensive care units and two combined adult and paediatric units in Australia, New Zealand and the United Kingdom. PATIENTS: All children admitted during the study period. In the analysis, 20787 patient admissions of children less than 16 years were included after 220 patients transferred to other ICUs and one patient still in ICU had been excluded. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: A revised model was developed by forward and backward logistic regression. Variable selection was based on the effect of including or dropping variables on discrimination and fit. The addition of three variables, all derived from the main reason for ICU admission, improved the fit across diagnostic groups. Data from seven units were used to derive a learning model that was tested using data from seven other units. The model fitted the test data well (deciles of risk goodness-of-fit chi(2 )8.14, p=0.42) and discriminated between death and survival well [area under the receiver operating characteristic (ROC) plot 0.90 (0.89-0.92)]. The final PIM2 model, derived from the entire sample of 19638 survivors and 1104 children who died, also fitted and discriminated well [chi(2 )11.56, p=0.17; area 0.90 (0.89-0.91)]. CONCLUSIONS: PIM2 has been re-calibrated to reflect the improvement that has occurred in intensive care outcome. PIM2 estimates mortality risk from data readily available at the time of ICU admission and is therefore suitable for continuous monitoring of the quality of paediatric intensive care.

Adult↗
PubMed2003

The use of extracorporeal techniques to remove humoral factors in sepsis.

OBJECTIVE: To determine whether there is sufficient evidence of a benefit of hemofiltration or plasma filtration in sepsis. DATA SOURCES: Medline search, search of references in articles found in Medline search, literature known to local experts. STUDY SELECTION: Trials and reports where clinical outcome measures were included. DATA EXTRACTION: Clinically relevant information was presented. DATA SYNTHESIS: Studies were grouped according to hemofiltration or plasma filtration and within each of these groups into animal or human studies; then they were graded from case report, through case series, nonrandomized trials, and randomized trials. CONCLUSION: There is a lack of randomized trials. The available studies show an absence of benefit for hemofiltration. Further studies are needed in plasma filtration.

Animals↗