title: A novel pediatric treatment intensity score: development and feasibility in heart failure patients with ventricular assist devices.
abstract: BACKGROUND
  The evolution of pharmacologic therapies and mechanical support including ventricular assist devices (VADs) has broadened the scope of care available to children with advanced heart failure. At the present time, there are only limited means of quantifying disease severity or the concomitant morbidity for this population. This study describes the development of a novel pediatric treatment intensity score (TIS), designed to quantify the burden of illness and clinical trajectory in children on VAD support.
  
  
  METHODS
  There were 5 clinical domains assessed: nutrition, respiratory support, activity level, cardiovascular medications, and care environment. A scale was developed through expert consensus. Higher scores indicate greater morbidity as reflected by intensity of medical management. To evaluate feasibility and face validity, the TIS was applied retrospectively to a subset of pediatric inpatients with VADs. The Bland-Altman method was used to assess limits of agreement.
  
  
  RESULTS
  The study comprised 39 patients with 42 implantations. Bland-Altman interobserver and intraobserver comparisons showed good agreement (mean differences in scores of 0.02, limits of agreement ±0.12). Trends in TIS were concordant with the overall clinical impression of improvement. Scores remained ≥0.6 preceding VAD implantation and peaked at 0.71 3 days after VAD implantation.
  
  
  CONCLUSIONS
  We describe a pediatric VAD scoring tool, to assess global patient morbidity and clinical recovery. We demonstrate feasibility of using this TIS in a test population of inpatients on VAD support.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics. Electronic address: ljmay@stanford.edu.
authors.forename: Lindsay J
authors.initials: LJ
authors.lastname: May
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Children's National Health System, Washington, DC.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ploutz
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Hollander
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California.
authors.forename: Olaf
authors.initials: O
authors.lastname: Reinhartz
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Almond
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics.
authors.forename: Sharon
authors.initials: S
authors.lastname: Chen
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California.
authors.forename: Katsuhide
authors.initials: K
authors.lastname: Maeda
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics.
authors.forename: Beth D
authors.initials: BD
authors.lastname: Kaufman
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics.
authors.forename: Justin
authors.initials: J
authors.lastname: Yeh
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics.
authors.forename: David N
authors.initials: DN
authors.lastname: Rosenthal
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies
keywords: heart failure; pediatric; score; ventricular assist device