OBJECTIVE:This study explores the relationship between T helper 17 (Th17)/regulatory T (Treg) cell balance, human umbilical cord mesenchymal stem cells (hUC-MSCs), and immune dysregulation in Henoch-Schönlein purpura (HSP). METHODS:Peripheral blood and clinical data were collected from children with acute HSP and healthy controls. Th17/Treg-related transcription factors and cytokines were measured by reverse transcription quantitative polymerase chain reaction (RT-qPCR) and enzyme-linked immunosorbent assay (ELISA). In vitro, human umbilical vein endothelial cells were stimulated with HSP serum and co-cultured with hUC-MSCs, with or without the signal transducer and activator of transcription 3 (STAT3) agonist colivelin TFA. STAT3 signaling, interleukin-6 (IL-6) expression, and endothelial migration were analyzed. In vivo, an ovalbumin-induced HSP rat model was treated with hUC-MSCs or stem cells plus colivelin TFA, followed by evaluation of pathological injury, STAT3 activation, and splenic Th17/Treg ratios. RESULTS:Children with HSP exhibited significant Th17/Treg imbalance, with elevated RORγt and IL-17 and decreased FOXP3 and IL-10 (P < 0.05). In vitro, stem cells suppressed IL-6/STAT3 signaling, reduced STAT3 phosphorylation, and promoted endothelial repair, whereas colivelin TFA abolished these effects. In the rat model, stem cell transplantation alleviated inflammation in skin, kidney, joint, and intestinal tissues by downregulating the IL-6/STAT3/RORγt axis and restoring Th17/Treg balance; these benefits were negated by colivelin TFA. CONCLUSION:Th17/Treg imbalance is an immunopathological feature of HSP. hUC-MSCs restore immune homeostasis by inhibiting STAT3 signaling, highlighting STAT3 as a potential therapeutic target and supporting further investigation of stem cell-based therapy.
OBJECTIVE:This study investigates how executive functions, motor coordination, and oral discourse are related to academic performance in children from public schools in Rio de Janeiro. METHOD:This longitudinal study assessed 75 children at the beginning (T1) and at the end (T2) of a school semester. Working memory was measured by the Digit Span test, eye-hand coordination by the Touch Test Disc (TTD), and oral discourse by non-semantic graph metrics (SpeechGraphs). Academic performance was assessed in Portuguese and Mathematics. RESULTS:Digit Span and TTD showed the strongest correlations with academic performance at T2, while graph metrics obtained from oral discourse were not significant predictors. Digit Span correlated positively with Portuguese (r = 0.505; p < 0.001) and Mathematics (r = 0.388; p = 0.002), while TTD correlated negatively with Portuguese (r = -0.453; p < 0.001) and Mathematics (r = -0.398; p = 0.001), i.e. better motor performance was associated with higher grades. Multiple regression analyses showed that Digit Span predicted Portuguese (β = 0.492; p < 0.001, 24.2% of variance). For Mathematics, both age (β = -0.501; p < 0.001) and Digit Span performance (β = 0.413; p = 0.002) were significant predictors. CONCLUSION:Working memory is a predictor of academic performance in both Portuguese and Mathematics, and eye-hand coordination also shows significant correlations with school grades, suggesting a relevant relationship between motor skills and learning. These findings highlight the importance of taking an integrated approach to cognitive and motor capacities in the educational context.
OBJECTIVE:To organize current knowledge and propose a comprehensive, treatment-focused classification system, called FEDSETUP, that guides clinicians through a stepwise, multidisciplinary approach to pediatric feeding difficulties, emphasizing intervention intensity matched to clinical need and severity. SOURCES:Development of the FEEDSETUP framework was grounded in a systematic approach to evidence synthesis, following PRISMA principles adapted for narrative framework development. Given the multidimensional nature of pediatric feeding difficulties-spanning medical, nutritional, behavioral, and developmental domains-a structured PICO framework was employed to guide literature identification and selection. SUMMARY OF THE FINDINGS:FEEDSETUP integrates a systematic initial assessment encompassing medical history, dietary evaluation, physical examination, and anthropometry. It categorizes feeding difficulties into distinct yet overlapping domains, including underlying organic disease, typical neophobia, micronutrient deficiency, difficulty concentrating on food, food phobia, and food selectivity. The framework prioritizes primary healthcare as the first line of intervention, with clear criteria for escalation to specialized multidisciplinary teams for more complex or severe cases, including those with Autism Spectrum Disorder comorbidity or Avoidant/Restrictive Food Intake Disorder. CONCLUSIONS:FEEDSETUP offers a comprehensive, integrated, and treatment-oriented approach to pediatric feeding difficulties, moving beyond diagnosis-centric models to provide a structured pathway for effective and individualized care across the spectrum of severity. The algorithm provides a practical, evidence-based roadmap for clinicians to ensure timely identification of associated behavioral, nutritional, and organic abnormalities. It facilitates interdisciplinary assessment, reduces diagnostic delays, and promotes coordinated care by matching intervention intensity to clinical presentation, thereby avoiding both under-treatment and over-medicalization.
OBJECTIVE:Although observational studies have proven a correlation between allergic diseases and short stature (SS), the causal relationship remains unestablished. Furthermore, inflammatory proteins are closely linked with both conditions; their potential mediating role has yet to be elucidated. This study aimed to probe into the causal linkage between allergic diseases and SS and the mediating role of inflammatory proteins. METHODS:A two-sample MR analysis was employed to explore the causal links between five allergic diseases (allergic rhinitis, childhood asthma, allergic conjunctivitis, atopic dermatitis (AD), and urticaria) and SS. A two-step MR approach was further used to investigate the mediating role of inflammatory proteins. RESULTS:Among the five allergic diseases, MR analysis only identified a suggestive positive correlation between AD and the risk of SS (OR = 1.720, 95%CI: 1.081-2.735, P = 0.022). A suggestive negative association was also found between AD and the level of the inflammatory protein AXIN1 (OR = 0.922, 95%CI: 0.855-0.995, P = 0.037). Mediation analysis revealed that AXIN1 levels potentially mediated 13.5% of the causal pathway between AD and SS risk. CONCLUSION:A potential positive causal link between AD and SS was revealed, highlighting the potential mediating role of the inflammatory protein AXIN1. These findings provide a scientific basis and a novel potential target for interventions aimed at improving height growth outcomes in patients with allergic diseases.
OBJECTIVE:To evaluate the effectiveness of circumcision and continuous antibiotic prophylaxis (CAP) in preventing febrile urinary tract infection (fUTI) in boys with high-grade primary vesicoureteral reflux (VUR). METHODS:This retrospective cohort included 114 boys younger than 5 years diagnosed with grades III-V primary VUR between June 2019 and June 2022. Patients were managed with observation (n = 14), CAP alone (n = 23), circumcision alone (n = 38), and combined CAP and circumcision (n = 39). The follow-up duration was 2 years. The incidence of fUTIs in each group was recorded, and associations between conservative management strategies and fUTI recurrence were analyzed. RESULTS:15 (13.2%) children experienced recurrent fUTIs. Recurrence rates were 42.9% in the observation group, 30.4% in the CAP group, 5.3% in the circumcision group, and 0% in the CAP+ circumcision group. Circumcision-containing groups (circumcision alone and CAP + circumcision) had significantly lower recurrence rates than non-circumcision groups (observation and CAP alone) (p < 0.05). Multivariable Firth-penalized logistic regression confirmed circumcision as an independent protective factor against fUTI recurrence (aOR = 0.09, 95% CI: 0.01-0.98, p = 0.042), while CAP alone showed no significant protective effect (aOR = 0.45, 95% CI: 0.06-3.21, p = 0.421). CONCLUSION:Circumcision significantly reduced fUTI recurrence in boys with grade III-V primary VUR and may represent an important component of conservative management in this high-risk population, whereas the added value of CAP remains uncertain.
OBJECTIVE:To update the evidence on sleep duration among children and adolescents, provide pooled estimates of mean sleep duration and compliance with sleep recommendations, and examine whether differences in measurement methods, assessment instruments, and guideline criteria contribute to variability in reported estimates. SOURCES:Eight databases (PubMed, PsycINFO, CINAHL, SciELO, Embase, Web of Science, Scopus, and LILACS) were searched from January 2020 to June 2025, supplemented by studies identified in a previous review. Population- or school-based observational studies of participants aged 0-18 years that reported sleep duration were eligible. Random-effects meta-analyses were conducted, and subgroup analyses and meta-regression were used to explore heterogeneity. SUMMARY OF THE FINDINGS:Eighty-four studies involving 177,074 participants were included. The pooled prevalence of adequate sleep duration was 45% (95% CI, 29-62%) among preschoolers, 65% (95% CI, 55-74%) among school-age children, and 47% (95% CI, 40-55%) among adolescents. Mean sleep duration decreased with age, ranging from 10.50 h (95%CI, 9.85-11.20) in preschoolers to 7.77 h (95%CI, 7.42-8.12) in adolescents. Questionnaire-based measures yielded higher estimates than accelerometry, and prevalence varied by the sleep guideline adopted. Heterogeneity was substantial across analyses (I² > 98%). CONCLUSIONS:Many Brazilian children and adolescents do not achieve recommended sleep duration, which can compromise their health and development. Although the pooled estimates should be interpreted with caution due to substantial between-study heterogeneity, the findings highlight the need for standardized sleep assessment and reporting to improve comparability across studies and strengthen epidemiological surveillance and public health planning.
OBJECTIVE:Although the effects of lactation on bone mass are frequently discussed, it is unknown whether these effects are intensified in breastfeeding mothers (BFM) who become donors (BFM-donors). Thus, the objective was to evaluate alterations in bone densitometry and bone metabolism in BFM-donors during six months of follow-up, compared with BFM-controls who did not donate maternal milk, to determine whether these changes would be intensified by the volume donated. METHODS:Data were obtained from two groups: 39 BFM-donors (six and twelve months postpartum) and 38 BFM-controls (up to 15 days [baseline] and six months postpartum). Donated milk volume, body mass index, and bone mineral density (BMD) of the lumbar spine, proximal femur, and total body were assessed by densitometry. Calcium, phosphorus, parathyroid hormone, 25(OH)D, estradiol, osteocalcin, bone alkaline phosphatase, and carboxy-terminal telopeptide were measured. Comparisons were performed using Student's t-test, followed by repeated-measures models and ANCOVA adjusted for confounders when appropriate. Effect size and statistical power were also calculated. RESULTS:BFM-donors showed bone mass mobilization similar to BFM-controls at six months, without influence of donated volume (9.0 ± 8.2 L). From six to 12 months postpartum, lumbar spine and femur BMD values increased (5% and 1.5%). CONCLUSIONS:Comparing BFM-donors at 12 months, versus BMF-controls at 15 days, even with continued complementary breastfeeding, densitometric results tended to return to the means seen 15 days postpartum. There were no correlations between BMD, bone markers, and total volume of donated milk.
Objective To systematically review and quantify the variation in quadriceps femoris muscle thickness in children admitted to pediatric intensive care units (PICUs) and to identify factors associated with this loss. Methods Searches were performed in Cochrane Library, Embase, PubMed, Scopus, and Web of Science databases for studies published without date restrictions. Observational studies assessing quadriceps thickness via ultrasonography at a minimum of two time points during PICU stay were included. The study protocol was registered in PROSPERO (CRD42024628869). Following PRISMA guidelines, data were extracted regarding study characteristics, muscle thickness variations, and associated clinical/demographic factors. Quantitative synthesis utilized random-effects models for percentage change and meta-analysis of proportions for prevalence. Results Nine studies (n = 536 patients) were included. The mean reduction in muscle thickness at 7 days was −7.89% (95% CI, −11.36% to −4.41%; p < 0.001). The maximum observed loss during admission was −10.77% (95% CI, −12.87% to −8.67%; p < 0.001). The pooled prevalence of clinically significant atrophy (> 10%) was 49.4% (95% CI, 44.0% to 54.7%). Key factors associated with greater loss included the use of neuromuscular blocking agents, older age (older children vs. infants), and cumulative protein and caloric deficits. Conclusions Muscle atrophy in critically ill children is an early, severe, and multifactorial phenomenon, affecting nearly half of the patients. Bedside ultrasonography monitoring is essential to guide early interventions and mitigate long-term functional impairment.
Objective To evaluate the prevalence and risk factors for recurrent respiratory tract infections in preschool children. Methods Studies on RRTIs in preschool children were retrieved from PubMed, Cochrane Library, Embase, Web of Science, CBM, CNKI, Wanfang, and VIP databases up to October 2025. Data was analyzed using Stata 15.0. Results Ten studies involving 15,271 preschoolers were included. Meta-analysis showed that the overall prevalence was 24.14% [95% CI (0.23,0.33)].A total of 11 risk factors for RRTIs in preschool children were identified, including: asthma (I² = 93.8%) [OR = 3.84, 95% CI (1.97, 7.47), P < 0.001], allergy(I² = 0) [OR = 2.27, 95% CI (2.06, 2.51), P < 0.001], dietary bias (I² = 65%) [OR = 2.10, 95% CI (1.37, 3.24), P = 0.001], smoking co-resident(I² = 42.7%) [OR = 1.83, 95% CI (1.44, 2.32), P < 0.001], low parental education level(I² = 0) [OR = 3.17, 95% CI (1.76, 5.69), P < 0.001], initial use of antibiotics < 6 months(I² = 0) [OR = 1.70, 95% CI (1.50, 1.93), P < 0.001], maternal BMI per 3 kg/m² increment(I² = 0) [OR = 1.18, 95% CI (1.08, 1.28), P < 0.001], and breastfeeding duration < 6 months(I² = 0) [OR = 1.26, 95% CI (1.12, 1.42), P < 0.001]. Conclusion The high prevalence (24.14%) of RRTIs in preschool children and the risk factors identified provide evidence for targeted prevention and intervention strategies.
OBJECTIVES:Urinary creatinine concentration is widely used to normalize urinary analytes. However, its reliability in preterm neonates remains uncertain. This study aimed to evaluate urinary creatinine concentrations in very low gestational age (VLGA) neonates and assess its impact on the interpretation of urinary creatinine normalized urinary amino acids. METHODS:Spot urine samples were collected from VLGA neonates (22-31 weeks gestational age, n = 32) and full-term neonates (≥ 37 weeks, n = 22) during the first days of life. Urinary creatinine was measured serially, and biological variation (within- and between-subject) was assessed. Urinary amino acids were measured on the 4th day in full-term neonates and in VLGA neonates at term-equivalent age using LC-MS/MS and expressed both as absolute concentrations (µmol/l) and normalized to creatinine (mmol/mol creatinine). RESULTS:Urinary creatinine concentrations were significantly lower in VLGA neonates compared to full-term neonates during the first days of life (p ≤ 0.004). A positive correlation between birth weight and urinary creatinine was observed (r = 0.46, p = 0.002). Within-subject biological variation was lower in VLGA neonates, while between-subject variation was comparable between groups. Urinary amino acid concentrations expressed in μmol/l did not differ significantly between groups, however, when expressed relative to creatinine, multiple significant differences emerged. CONCLUSIONS:Gestational age should be considered when interpreting creatinine normalized urinary amino acids concentrations in neonates.
Objective a) To verify the applicability of anthropometric indices (body mass index (BMI), tri- weight index (TWI), body surface area (BSA)) for evaluating velocity and agility tests in children and adolescents, and to propose reference values. Methods A descriptive cross-sectional (correlational) study was designed in 1573 schoolchildren aged 6 to 17 years. Weight and height were assessed. BMI, TWI, and BSA were calculated. The 20-meter sprint and agility (5 meters x 10 repititions) test was evaluated. Results In the individual analysis, the explanatory power for velocity and agility for BMI was almost nil. In the case of the TWI (r² = 0.123 and 0.110) and BSA (r² = 0.157 and 0.211), they showed significant explanatory power. When age was incorporated, the predictive power significantly increased. For BMI+age (r² = 0.342 and 0.435); TWI+age (r² = 0.382 and 0.467), and BSA+age (r² = 0.292 and 0.394). When sex was added, the results showed a further improvement. For BMI+age+sex (r² = 0.409 and 0.498); TWI+age+sex (speed test (r² = 0.435 and 0.517) and BSA+age+ sex (r² = 0.373 and 0.470). Conclusion The TWI better explained motor performance than the BMI and BSA in Chilean schoolchildren. Models that included TWI along with age and sex indicated that the TWI could be an alternative for assessing velocity and agility. Furthermore, percentiles were developed for the 20-meter sprint and the 5-meter agility test (10 repetitions), which are useful for monitoring and interpreting changes in the physical performance of schoolchildren.
OBJECTIVE:To characterize clinical outcomes of gene replacement therapy administered after symptom onset in a small group of children with 5q spinal muscular atrophy (SMA) and to describe its impact on motor function and supportive care needs in real-world practice. METHODS:Observational cohort study with retrospective and prospective data collection at a single pediatric center. Children with molecularly confirmed type 1 or type 2 5q SMA who received onasemnogene abeparvovec and remained in multidisciplinary follow-up were consecutively included. Due to the small sample (n = 7) and patient heterogeneity, analysis was exclusively descriptive. RESULTS:Seven symptomatic children were evaluated (six type 1, one type 2). After treatment, motor milestones showed localized improvements; all type 1 patients achieved head control and sitting with support, and 83.3% achieved independent sitting. The type 2 patient achieved independent ambulation. Adverse events occurred in 85.7% of patients and were mostly mild to moderate, though one case of thrombotic microangiopathy required dialysis with favorable recovery. Despite motor gains, prior and simultaneous use of other therapies (nusinersen, risdiplam) acted as confounding factors, and most children remained dependent on noninvasive ventilation and gastrostomy. CONCLUSIONS:In this small and heterogeneous cohort, gene therapy after symptom onset was primarily associated with clinical stabilization and limited motor milestone acquisition, while established respiratory and nutritional impairments persisted. These results emphasize the need for realistic treatment counseling and reinforce the importance of early diagnosis.
Objective: Intraoperative hypotension is associated with adverse postoperative outcomes, yet evidence in the neonatal population is limited. This study aimed to investigate the incidence, risk factors, and prognostic significance of intraoperative hypotension in this population. Methods: This single-center retrospective study included 1712 neonates undergoing non-cardiac surgery from 2020 to 2025 at a tertiary children’s hospital in China. Intraoperative hypotension was defined as a reduction in mean arterial pressure of more than 20% from the preoperative baseline and lasting for more than 5 min. Multivariate logistic regression identified independent risk factors. Results: The incidence of intraoperative hypotension was 59.8% (1024/1712). Independent risk factors included American Society of Anesthesiologists Physical Status Classification > Ⅲ (OR = 1.357, 95% CI: 1.079–1.706, P = 0.009), emergency surgery (OR = 1.323, 95% CI: 1.054–1.660, P = 0.016), surgery duration > 60 min (OR = 1.457, 95% CI: 1.162–1.826, P = 0.001), thoracic surgery (OR = 1.727, 95% CI: 1.053–2.831, P = 0.030), preoperative congenital heart disease (OR = 1.379, 95% CI: 1.117–1.702, P = 0.003), and preoperative acidosis (OR = 1.349, 95% CI: 1.036–1.757, P = 0.026). Higher gestational age (OR = 0.936, 95% CI: 0.891–0.983, P = 0.008) and neurosurgery (OR = 0.566, 95% CI: 0.385–0.832, P = 0.004) were protective factors. Intraoperative hypotension was associated with prolonged postoperative recovery and increased acute kidney injury and intraventricular hemorrhage (all P < 0.05). Conclusions: Intraoperative hypotension is highly prevalent in neonatal non-cardiac surgery and was associated with short-term outcomes. Identified risk and protective factors may guide perioperative hemodynamic optimization in this vulnerable population.
Objective The aim of this systematic review (SR) is to evaluate the relationship between congenital infections (Toxoplasmosis, Cytomegalovirus, Rubella, Herpes simplex type 1 and 2, HIV, Zika, and Syphilis) and the development of Autism Spectrum Disorder (ASD). Data source The authors seek to identify loopholes in the current knowledge about this content and to understand the role of congenital infections in children’s neurodevelopment. After the systematic search, 32 articles were included. Quality of articles was evaluated by the e Newcastle-Ottawa Scale (NOS). Findings The data obtained were heterogeneous; the NOS varied from 4 to 9. In 19 studies, an association between congenital infection and the development of ASD and/or features of this spectrum was not observed. Furthermore, the present findings indicate that the link between congenital infections and ASD varies depending on the pathogen and there is no common causal factor among the diseases, as their mechanisms are not yet fully understood. Conclusion This review highlights that there is a possible correlation between some congenital infections and the development of ASD, as is the case with CMV, Zika, Rubella and Toxoplasmosis infection. As the mechanisms are not yet fully understood, there is a need for further studies and research on this topic to bridge the existing knowledge gap regarding its mechanisms.
Objective To evaluate the factors linked to Food Insecurity (FI) in children and adolescents with Type 1 Diabetes Mellitus (DM1). Methods A cross-sectional study was conducted with children and adolescents at the Diabetes Outpatient Clinic of the IPPMG/UFRJ. Procedures included assessing FI levels using the Brazilian Food Insecurity Scale (EBIA). Sociodemographic data collected included age, gender, number of family members, caregiver's education, social benefits, and income. A 5% significance level was used, with 95% confidence intervals. Results The sample included 130 children and adolescents, mostly female (60.8%, n = 79), and most did not receive social benefits (63.8%, n = 81). In most cases, the mother was the primary caregiver (77.7%, n = 101), and the caregivers had at least completed high school (80%, n = 104). Most participants were eutrophic based on BMI/age and sex (58.4%, n = 76) and had appropriate height for their age (96.9%, n = 126). The prevalence of FI was 67.4% (n = 87), with 50.4% (n = 65) experiencing mild FI, 11.6% (n = 15) moderate FI, and 5.4% (n = 7) severe FI. Conclusion A significant association was found between FI and income, caregiver's education, and receipt of benefits. The study highlights income as a key factor in food acquisition. These findings stress the need for intersectoral actions to develop public policies and programs aimed at reducing poverty, promoting food security, and ensuring adequate, healthy nutrition, especially within this population.
OBJECTIVE:To evaluate the incidence and epidemiological, clinical, and laboratory characteristics of Central Precocious Puberty (CPP) before, during, and after the COVID-19 pandemic in Goiás, Brazil. METHOD:This retrospective, longitudinal, observational study with a quantitative approach was conducted in Goiás using administrative records of high-cost medication dispensing. All patients registered in the state dispensing center who initiated treatment between 2018 and 2023 were included. Data were analyzed using the Statistical Package for Social Sciences (IBM Corporation, Armonk, USA), version 26.0. Statistical significance was set at 5% (p < 0.05). RESULTS:A total of 910 CPP treatment requests were evaluated, including 153 before the pandemic, 390 during 2020-2021, and 367 during 2022-2023. This corresponded to increases of 154% and 140% during the pandemic and post-pandemic periods, respectively (p < 0.001). From 2020 onward, patients started gonadotropin-releasing hormone analog therapy at younger ages (104.84 ± 12.52 vs. 107.17 ± 13.42 months; p = 0.027), but showed more advanced pubertal development, with higher Tanner stages (B/G stage 4: 15.9% and 21.4% vs. 8.6%; p = 0.035) and higher stimulated LH levels (22.39 ± 16.81 and 24.64 ± 22.13 vs. 19.87 ± 18.08 mIU/mL; p = 0.046). CONCLUSIONS:CPP incidence increased significantly in Goiás during and after the COVID-19 pandemic. Patients also presented more advanced clinical and laboratory features than those diagnosed before the pandemic.
OBJECTIVE:To evaluate the Pediatric Respiratory Assessment Measure (PRAM) score for hospital admission and prolonged stay risk stratification in the emergency department (ED) at different time points. METHOD:Retrospective cohort study using prospectively collected protocol data (August 2023-March 2025) at a tertiary pediatric ED. Patients aged 2-17 years with acute asthma exacerbations were included; those with systemic comorbidities, other chronic lung diseases, or confounding acute conditions were excluded. PRAM was assessed hourly (PRAM 0 to 4). Outcomes were hospital admission and prolonged ED stay (> 3 h). RESULTS:A total of 428 visits were analyzed (35.0% hospital admission rate). PRAM demonstrated satisfactory discriminatory capacity for admission at triage (AUC: 0.791; 95% CI: 0.745-0.836; p < 0.001), with optimized accuracy during serial assessments, performing best at the second hour (PRAM 2; AUC: 0.829; 95% CI: 0.773-0.885; p < 0.001). For predicting prolonged ED stay, the score showed moderate accuracy at the second hour (AUC: 0.677; p < 0.001), with no significant correlation between sequential scores and time to admission decision (p > 0.05). CONCLUSIONS:PRAM is a valuable, dynamic risk-stratification tool for pediatric asthma exacerbations. Serial assessments provide superior prognostic accuracy compared to a single static measurement at admission by actively reflecting therapeutic response. Although its ability to predict operational outcomes is restricted by non-clinical factors, the score demonstrates consistent utility for standardizing clinical assessment and supporting medical disposition in the ED.
