A study of predictors of outcome in paediatric intensive care unit with special reference to SOFA score
DOI:
https://doi.org/10.18203/2349-3291.ijcp20230077Keywords:
SOFA score, MODS, Immunization, SepsisAbstract
Background: Multi-organ dysfunction syndrome (MODS) is the leading cause of morbidity and mortality for patients admitted in Pediatric Intensive care unit. The Sequential organ failure assessment (SOFA) score is an objective score that allows for calculation of both the number and the severity of organ dysfunction in six organ systems. It is a six-organ dysfunction score measuring multiple organ failure daily. Each organ is graded from 0 (normal) to 4 (the most abnormal). This scoring system guides the efficient utilization of hospital resources, especially in a resource starved setting and useful to evaluate the prognostication, to counsel the guardians and to decide therapeutic interventions. The score can also be a useful in clinical research tool to evaluate various therapeutic interventions in MODS. The aim of the study was to predict outcome in pediatric intensive care unit with special reference to SOFA score in patients admitted to civil hospital, Ahmedabad.
Methods: We have randomly selected 120 patients who were admitted in pediatric intensive care unit of tertiary care hospital and full-filing inclusion and exclusion criteria included in our study.
Results: There are multiple factors responsible for predicting the outcome in critically ill patients admitted in pediatric intensive care unit. Patients with complete immunization status have better outcome as compared to patients with incomplete immunization and unimmunized status. Patients with higher socioeconomic class have slightly better outcome as compared to patients with lower socioeconomic class.
Conclusions: SOFA score is a good objective score as a predictor of mortality in critically ill patients. But, if SOFA is calculated at the time of admission, then it has poor diagnostic accuracy in prediction of outcome. So, SOFA score at 72 hours of admission (T72) and delta SOFA (T72-T0) are better predictors of poor outcome as compared to SOFA score at admission (T0).
References
Geme KS, Shah B, Wilson T. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2019: 572-583.
Tantaleán JA, León RJ, Santos AA, Sánchez E. Multiple organ dysfunction syndrome in children. Pediatr Crit Care Med. 2003;4(2):181-5.
Yeh TS, Pollack MM, Ruttimann UE, Holbrook PR, Fields AI. Validation of a physiologic stability index for use in critically ill infants and children. Pediatr Res. 1984;18(5):445-51.
Straney L, Clements A, Parslow RC, Pearson G, Shann F, Alexander J, et al. Paediatric index of mortality 3: an updated model for predicting mortality in pediatric intensive care. Pediatr Crit Care Med. 2013;14(7):673-81.
Leteurtre S, Martinot A, Duhamel A, Gauvin F, Grandbastien B, Nam TV, et al. Development of a pediatric multiple organ dysfunction score: use of two strategies. Med Decis Making. 1999;19(4):399-410.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707-10.
Moreno R, Vincent JL, Matos R, Mendonça A, Cantraine F, Thijs L, et al. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related Problems of the ESICM. Intensive Care Med. 1999;25(7):686-96.
Gemke RJ, Bonsel GJ, Vught AJ. Effectiveness and efficiency of a Dutch pediatric intensive care unit: validity and application of the Pediatric Risk of Mortality score. Crit Care Med. 1994;22(9):1477-84.
Kanter RK, Edge WE, Caldwell CR, Nocera MA, Orr RA. Pediatric mortality probability estimated from pre-ICU severity of illness. Pediatrics. 1997;99(1):59-63.
Proulx F, Gauthier M, Nadeau D, Lacroix J, Farrell CA. Timing and predictors of death in pediatric patients with multiple organ system failure. Crit Care Med. 1994;22(6):1025-31.
Matics TJ, Sanchez-Pinto LN. Adaptation and Validation of a Pediatric Sequential Organ Failure Assessment Score and Evaluation of the Sepsis-3 Definitions in Critically Ill Children. JAMA Pediatr. 2017;171(10):e172352.
Park K. Park'S Textbook Of Preventive And Social Medicine. 25th ed. Bhanot; 2019: 572-664.
Earan SK, Dhandapani L, Arunagirinathan A, Kantamneni S. Clinical Spectrum and Epidemiological Profile of Patients Admitted to Pediatric Intensive Care Unit at a Tertiary Care Centre in South India. Int J Sci Study 2016;4(3)187-91.
Gogia P, Prasad S. Utility of sequential organ failure assessment score in prognosticating sick children in pediatric intensive care unit. Int J Contemp Pediatr. 2016;3:1193-6.
