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Modified SANART Score for Pediatrics

The Modified SANART Score assesses patient severity and predicts adverse outcomes, guiding urgent care and decision-making. It standardizes evaluation, ensuring timely and appropriate responses, tailored for specific patient populations and clinical settings.

Categories (total 6)

Normal

Mild NE

Moderate NE

Severe NE

1. Level of consciousness

Alert, responsive to external stimuli (state-dependent, e.g. post feeds)

Hyper-alert has a stare, jitteriness, high-pitched cry, exaggerated response to minimal stimuli, inconsolable

Lethargic

Stupor/coma

2. Spontaneous activity

Changes position when awake

Normal or decreased

Decreased activity

No activity

3. Posture

Predominantly flexed when quiet

Mild flexion of distal joints (fingers, wrist usually)

Moderate flexion of distal joint, complete extension

Decerebrate

4. Tone

Strong flexor tone in all extremities + strong flexor hip tone

Normal or slightly increased peripheral tone

Hypotonia (focal or general) or hypertonia

Flaccid Rigid

5. Primitive reflexes (circle only the highest level in each sign; the maximum score is only 1 in any one category)





Suck

Strong, easily illicit

Weak, poor

Weak but has a bite

Absent

Moro

Complete

Partial response, low threshold to illicit

Incomplete

Absent

6. Autonomic system (circle only the highest level in each sign; the maximum score is only 1 in any one category)





Pupils

In dark: 2.5–4.5 mm; in light: 1.5–2.5 mm

Mydriasis

Constricted

Deviation/dilated/non-reactive to light

Heart rate

100–160 bpm

Tachycardia (HR > 160)

Bradycardia (HR < 100)

Variable HR

Respiration

Regular respirations

Hyperventilation (RR > 60/min)

Periodic breathing

Apnoea or requires a ventilator

Total score





 

Introduction

In pediatric medicine, clinical scoring systems are invaluable tools for assessing the severity of a patient's condition and predicting outcomes. One such scoring system, though not widely recognized in its "modified" form, is the SANART score. This article provides a deep dive into the principles behind creating and using a modified SANART score, emphasizing its application in pediatric clinical practice. The goal is to help pediatric residents understand how to systematically evaluate and manage patients using this scoring system.

Background and Importance of Clinical Scoring Systems

Clinical scoring systems in pediatrics help standardize the assessment of illness severity and guide treatment decisions. They are particularly useful in emergency settings, where rapid and accurate evaluation is crucial. The SANART score, like other scoring systems, aims to quantify the risk of adverse outcomes based on clinical parameters.

Key Components of the Modified SANART Score

  1. Symptoms

    • Chest Pain: While less common in pediatrics compared to adults, chest pain can indicate serious conditions such as myocarditis, pericarditis, or musculoskeletal issues. Assessing the severity and nature of chest pain is crucial.

      • Severe (2 points)

      • Mild (1 point)

    • Dyspnea: Difficulty breathing can be a sign of respiratory or cardiac conditions, such as asthma, bronchiolitis, or heart failure.

      • Severe (2 points)

      • Mild (1 point)

    • Fever: A common pediatric symptom that can indicate infection or inflammatory conditions.

      • Present (1 point)

  2. Vital Signs

    • Heart Rate: Tachycardia or bradycardia can indicate underlying pathology.

      • 100 bpm (1 point)

      • <60 bpm (1 point)

    • Blood Pressure: Hypotension or hypertension in children may indicate shock or other cardiovascular issues.

      • Systolic <90 mmHg or >180 mmHg (2 points)

    • Respiratory Rate: Increased respiratory rate is often a sign of respiratory distress.

      • 20 breaths/min (1 point)

    • Oxygen Saturation: Hypoxemia is a critical indicator of respiratory failure or severe illness.

      • <92% (2 points)

  3. Laboratory Results

    • Elevated Troponin: Though more specific to adults, elevated troponin in children can indicate myocarditis or myocardial injury.

      • Present (2 points)

    • Elevated D-dimer: This can suggest thromboembolic events, though less common in pediatrics.

      • Present (1 point)

    • Abnormal CBC: Leukocytosis, anemia, or thrombocytopenia can indicate infection, inflammation, or hematologic disorders.

      • Present (1 point)

Calculation of the Total Score

Summing the points for each parameter provides a total score that categorizes the patient's risk:

  • Low Risk: 0-3 points

  • Moderate Risk: 4-6 points

  • High Risk: 7-10 points

Clinical Application

A pediatric resident must apply the modified SANART score to evaluate and manage patients systematically. Here’s an illustrative case study:

Case Study: A 10-year-old male presents to the emergency department with complaints of chest pain and difficulty breathing. His vital signs are as follows: heart rate 110 bpm, respiratory rate 25 breaths/min, blood pressure 105/70 mmHg, and oxygen saturation 90%. Initial laboratory tests show an elevated troponin level.

Score Calculation:

  • Chest Pain (Severe): 2 points

  • Dyspnea (Severe): 2 points

  • Heart Rate (>100 bpm): 1 point

  • Respiratory Rate (>20 breaths/min): 1 point

  • Oxygen Saturation (<92%): 2 points

  • Elevated Troponin: 2 points

Total Score: 10 points (High Risk)

Management: Given the high-risk score, the patient requires:

  1. Immediate Stabilization:

    • Administer supplemental oxygen to maintain oxygen saturation above 92%.

    • Continuous cardiac and respiratory monitoring.

  2. Diagnostic Evaluation:

    • Obtain a chest X-ray and ECG to assess cardiac and pulmonary status.

    • Echocardiography to evaluate cardiac function and structure.

    • Repeat troponin and obtain a full panel of cardiac enzymes.

  3. Therapeutic Interventions:

    • Initiate intravenous access and prepare for potential advanced cardiac support.

    • Administer empiric broad-spectrum antibiotics if an infectious cause is suspected (e.g., myocarditis).

    • Consult cardiology for further evaluation and management.

Interpretation and Clinical Decision-Making

A high modified SANART score indicates a severe condition requiring urgent intervention. In this case, the scoring system helps prioritize actions and mobilize resources to stabilize the patient.

 

Conclusion

Understanding and applying the modified SANART score can significantly enhance a pediatric resident's ability to assess and manage critically ill patients. This scoring system provides a structured, evidence-based approach to clinical decision-making, ensuring that all relevant clinical parameters are considered. Regular practice and familiarity with such scoring systems will prepare pediatric residents for real-world clinical scenarios, ultimately improving patient outcomes.


 

References

  • American Academy of Pediatrics. "Pediatric Advanced Life Support." AAP Publications, latest edition.

  • Kleinman, M.E., et al. "Pediatric Basic and Advanced Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations." Circulation. 2020.

  • "Nelson Textbook of Pediatrics," latest edition. Elsevier.

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