Paediatric assessment score as predictor of mortality in pediatric intensive care units
DOI:
https://doi.org/10.18203/2349-3291.ijcp20250759Keywords:
Pediatric sequential organ failure assessment score, Pediatric intensive care unitsAbstract
Background: To study paediatric assessment score (pSOFA) as predictor of mortality in PICU.
Methods: This prospective study is conducted in children of age group one month to 12 yrs, who were admitted in the PICU of a tertiary care hospital, G.G Hospital, Jamnagar in 1 year time period of around 150 patients. The variables include SpO2: FiO2 ratio, platelet counts, Total S. bilirubin (mg/dl), mean blood pressure by age group with use of vasoactive, Glasgow Coma Scale and S. creatinine (mg/dl). Observed values were noted in case record form, scores were given for individual components according to p-SOFA score assessment chart. A total score was calculated for each patient.
Results: The use of a scoring system and audit of ICUs has not been widely reported in India. In our study, The pSOFA score demonstrated good performance in predicting mortality, with an area under the ROC curve of 0.86 (95% CI: 0.79-0.93). A score ≥6 had a sensitivity of 84.6%, specificity of 69.4%, positive predictive value of 50.7% and negative predictive value of 92.2% for mortality.
Conclusions: Pediatric SOFA score (pSOFA) score can be used as a reliable prognostic predictor of mortality among PICU patients. pSOFA score provides an objective assessment of severity of illness. Earlier assessment of disease severity based on pSOFA score helps in vigorous management and better patient treatment, which helps in patient survival. Factors such as need for mechanical ventilation and inotrope use were significantly associated with mortality.
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References
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):172352. DOI: https://doi.org/10.1001/jamapediatrics.2017.2352
Fleiss N, Polin RA. Sequential organ failure assessment scores to predict outcomes: from adults to neonates. Curr Opin Pediatr. 2023;35(2):218-22. DOI: https://doi.org/10.1097/MOP.0000000000001207
Sankar J, Saravanan M, Bansal A. Sequential organ failure assessment score as a predictor of outcome in sepsis in pediatric intensive care unit. J Pediatr Intensive Care. 2021;10(2):110-7. DOI: https://doi.org/10.1055/s-0040-1714705
Schlapbach LJ, Kissoon N. Defining pediatric sepsis. JAMA Pediatr. 2022;176(4):216317.
Zhao C, Xin MY, Li J. Comparing the precision of the pSOFA and SIRS scores in predicting sepsis-related deaths among hospitalized children: a multi-center retrospective cohort study. World J Emerg Med. 2022;13(4):259-65. DOI: https://doi.org/10.5847/wjem.j.1920-8642.2022.060
Malik A, Taksande A, Meshram R. Pediatric sequential organ assessment score: a comprehensive review of the prognostic marker in the pediatric intensive care unit. Cureus. 2024;16(5):60034. DOI: https://doi.org/10.7759/cureus.60034
Weiss SL, Lemoine D, Mukherjee R. Automated calculator for the pediatric sequential organ failure assessment score: development and external validation in a single-center 7-year cohort. Pediatr Crit Care Med. 2023;24(8):659-68.
Kissoon N, Carcillo JA, Espinosa V. Pediatric sepsis: global implications of the systemic inflammatory response syndrome and multiple organ dysfunction syndrome. Intensive Care Med. 2016;42(12):2035–47.
Khilnani P, Sarma D, Singh R. Demographic profile and outcome analysis of critically ill children admitted in pediatric intensive care unit: A single center study from India. Indian J Crit Care Med. 2018;22(2):103–8.
Kanthimathinathan HK, Scholefield BR. Pediatric sepsis management: Advances and ongoing challenges. Crit Care. 2015;19(1):209.
Namachivayam P, Shann F, Shekerdemian L. Impact of an intensive care unit admission on long-term outcomes for critically ill children. Intensive Care Med. 2017;36(6):915–21.
Moreno R, Vincent JL, Matos A. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care: results of a prospective, multicentre study. Intensive Care Med. 1999;25:686-96. DOI: https://doi.org/10.1007/s001340050931
Keenan HT, Bratton SL, Martin-Herz SP. Disease burden and outcome in pediatric critical care patients: Respiratory conditions and infection dominate. Crit Care Med. 2019;47(6):506-14.
Watson RS, Carcillo JA, Linde-Zwirble WT. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med. 2017;186(8):870–6.
Leteurtre S, Duhamel A, Grandbastien B. Daily estimation of severity of organ dysfunctions in critically ill children by using the PELOD-2 score: A prospective multicenter study. Lancet Respir Med. 2017;1(6):445–53.
Straney L, Clements A, Alexander J. Paediatric index of mortality 3: An updated model for predicting mortality in pediatric intensive care. Pediatr Crit Care Med. 2017;14(7):673–81. DOI: https://doi.org/10.1097/PCC.0b013e31829760cf
Pollack MM, Holubkov R, Reeder R. Pediatric intensive care outcomes: A prospective, multicenter cohort study. Crit Care Med. 2016;44(12):2339–48.
Marcin JP, Rutan E, Rapaport S. The use of inotropic and vasopressor agents in children with shock: Review of evidence. Pediatr Crit Care Med. 2016;14(1):e42-e48
Schlapbach LJ, Straney L, Alexander J. Pediatric sepsis definitions and outcome prediction using the paediatric sequential organ failure assessment (pSOFA) score: A multicenter study. Lancet Child Adolesc Health. 2018;2(4):253–61.
Brierley J, Carcillo JA, Choong K. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. 2016;37(2):666–88. DOI: https://doi.org/10.1097/CCM.0b013e31819323c6