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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

2006; Lippincott Williams & Wilkins; Volume: 34; Issue: 7 Linguagem: Inglês

10.1097/01.ccm.0000220765.22184.ed

1530-0293

Paul Shore, Linda Liu Hand, Lonnie Roy, Premal M. Trivedi, Patrick M. Kochanek, P. David Adelson,

Cardiac Arrest and Resuscitation

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 <or= 8) pediatric traumatic brain injury (TBI).Case-control study via retrospective review of medical records.Tertiary-care, university-based children's hospital intensive care unit.Randomly selected patients <or=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).None.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).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.