Use of the nursing acuity score in children admitted to a pediatric oncology intensive care unit

Objective: To determine whether a unit specific nursing acuity score is useful for assessing patients with cancer admitted to the pediatric intensive care unit. Design: Prospective, cohort analysis. Setting: The intensive care unit of a tertiary-care pediatric oncology hospital. Patients: A total of 219 patients admitted to the pediatric intensive care unit with a diagnosis of cancer or after hematopoietic stem cell transplantation. Interventions: The nursing acuity scores obtained during the second shift after admission were recorded and compared with rates of mortality. These nursing acuity scores were also compared with the Pediatric Risk of Mortality (PRISM III) and Therapeutic Intervention Scoring System (TISS-28) scores recorded during the first day of intensive care unit admission. Main Results: Mortality differed across the nursing acuity categories (0%, 7.5%, 20.8%, and 47.4%; p=.0002). TISS-28 and PRISM III scores progressively increased with each increase in the categorical nursing score and differed significantly among these levels (TISS-28, p=.0078; PRISM III, p=.0327). The Spearman correlation coefficients between the nursing score and TISS-28 and PRISM III were 0.432 and 0.285, respectively (p < .0001). Conclusions: The nursing acuity score accurately predicts survival in pediatric patients with cancer, correlates with established indexes of severity of illness and predictors of mortality, and identifies different mortalities across the nursing acuity categories. Although its predictive value may have been enhanced by the use of a second shift score, these findings suggest that it may be a useful tool in this patient population and affirms the insight of the bedside nurse in assessing severity of illness.