Pediatric Simplified Acute Physiology Score II: Establishment of a New, Repeatable Pediatric Mortality Risk Assessment Score.

Stefan Irschik,Jennifer B Brandt,Christoph Krall,Johann Golej,Gerald Schlager,Jelena Veljkovic,Michael Hermon

doi:10.3389/fped.2021.757822

Abstract

Objectives: In critical care it is crucial to appropriately assess the risk of mortality for each patient. This is especially relevant in pediatrics, with its need for accurate and repeatable scoring. Aim of this study was to evaluate an age-adapted version of the expanded Simplified Acute Physiology Score II; (p-SAPS II), a repeatable, newly-designed scoring system compared to established scores (Pediatric Sequential Organ Failure Assessment Score/pSOFA, Pediatric Logistic Organ Dysfunction Score-2/PELOD-2 and Pediatric Index of Mortality 3/PIM3).Design: This retrospective cohort pilot study included data collected from patients admitted to the Pediatric Intensive Care Unit (PICU) at the Medical University of Vienna between July 2017 through December 2018.Patients: 231 admissions were included, comprising neonates (gestational age of ≥ 37 weeks) and patients up to 18 years of age with a PICU stay longer than 48 h.Main Outcomes: Mortality risk prediction and discrimination between survivors and non-survivors were the main outcomes of this study. The primary statistical methods for evaluating the performance of each score were the area under the receiver operating characteristic curve (AUROC) and goodness-of-fit test.Results: Highest AUROC curve was calculated for p-SAPS II (AUC = 0.86; 95% CI: 0.77–0.96; p < 0.001). This was significantly higher than the AUROCs of PELOD-2/pSOFA but not of PIM3. However, in a logistic regression model including p-SAPS II and PIM3 as covariates, p-SAPS II had a significant effect on the accuracy of prediction (p = 0.003). Nevertheless, according to the goodness-of-fit test for p-SAPS II and PIM3, p-SAPS II overestimated the number of deaths, whereas PIM3 showed acceptable estimations. Repeatability testing showed increasing AUROC values for p-SAPS II throughout the clinical stay (0.96 at day 28) but still no significant difference to PIM 3. The prediction accuracy, although improved over the days and even exceeded PIM 3.Conclusions: The newly-created p-SAPS II performed better than the established PIM3 in terms of discriminating between survivors and non-survivors. Furthermore, p-SAPS II can be assessed repeatably throughout a patient's PICU stay what improves mortality prediction. However, there is still a need to optimize calibration of the score to accurately predict mortality sooner throughout the clinical stay.

Highlights

One of the major challenges Intensive Care Units (ICUs) face is to objectively evaluate a patient’s condition in cases of critical illness to derive a predictive outcome
While death rates are usually low in pediatric intensive care (PICU) patients, especially when compared to their adult counterparts [2], a scoring method useable across all situations–and for every patient–is needed to produce accurate predictions of high-mortality risk patients
Pediatric Logistic Organ Dysfunction Score (PELOD) was designed for children with multiple organ dysfunction syndrome [2, 10], while Pediatric Sequential Organ Failure Assessment Score (pSOFA) assesses the severity of organ dysfunction in the framework of sepsis [8, 9]

Summary

Introduction

One of the major challenges Intensive Care Units (ICUs) face is to objectively evaluate a patient’s condition in cases of critical illness to derive a predictive outcome. Assessing a patient’s mortality risk at time of admission is of highest priority in clinical routines. While death rates are usually low in pediatric intensive care (PICU) patients, especially when compared to their adult counterparts [2], a scoring method useable across all situations–and for every patient–is needed to produce accurate predictions of high-mortality risk patients. Attempts have been made to create new scores or update and adapt existing scores for use in pediatrics, such as Pediatric Index of Mortality (PIM) [5,6,7], Pediatric/Age-adapted Sequential Organ Function Assessment Score (pSofa/ageadapted SOFA) [8, 9] or the Pediatric Logistic Organ Dysfunction Score (PELOD) [2, 10]. PELOD was designed for children with multiple organ dysfunction syndrome [2, 10], while pSOFA assesses the severity of organ dysfunction in the framework of sepsis [8, 9]

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Conclusion