Abstract
Background: Recently pediatric sequential organ failure assessment (pSOFA) score was adapted and validated in critically ill children. This study was aimed to evaluate the feasibility of addition of echocardiographic parameters to paediatric version of SOFA score (pSOFA-E score) and to adapt and validate with reference to pSOFA score in predicting the mortality of critically ill children.Subjects and Methods:This hospital based prospective, observational, analytical study was conducted in the Department of Paediatrics, A. J Hospital, Mangalore, Karnataka, from November 2017 to November 2019. A total of 74 cases were studied. Result:Most of the children were aged <1 year (41.89%). Majority of the patients (62.16%) improved and 37.84% of the patients expired. The mean and median pSOFA-E scores were 10.53±4.06 and 10 respectively and pSOFA-E score of 5-8 was noted in most of the children (32.43%). Mortality was significantly high in children with pSOFA-E score between 9-12 (39.13%), 13-16 (77.78%), 17-20 (83.33%) (p<0.001). Receiver operating characteristic curve (ROC) yielded area under curve (AUC) of 0.920 and 0.791 with a cut-off value of 11.5 in predicting mortality. Significantly higher number of children with pSOFA-E score of ≥ 11.5 had positive blood culture (30%). Conclusion:The findings of the present study validate and emphasize that, addition of score devised by requirement of ionotropes to maintain adequate ejection fraction defy simple bedside echocardiography to pSOFA score is highly useful and accurate in discrimination of PICU mortality, morbidity and cardiovascular status/ compromise of body.
Highlights
Several MODS scoring systems have been developed and validated mainly in adults.an equivalent MODS scoring system is not available for critically ill children
In the present study in an attempt to improve the diagnostic performance we evaluated the hemodynamic condition of the patient based on transthoracic echocardiography (TTE) at bedside by the pediatric cardiologist
The present study was planned to evaluate the feasibility of addition of echocardiographic parameters to paediatric version of Sequential Organ Failure Assessment (SOFA) score so as to formulate the pSOFAECHO [pediatric sequential organ failure assessment (pSOFA)-E] score and to adapt and validate with reference to pSOFA score in predicting the mortality of critically ill children in our settings, which is first of its kind
Summary
Several MODS scoring systems have been developed and validated mainly in adults.an equivalent MODS scoring system is not available for critically ill children. The Sepsis-3 definitions are expected to be widely adopted and, by extension, the use of SOFA score in patients with confirmed or suspected infection.[1] Echocardiography is currently considered a key tool for the hemodynamic assessment in Intensive Care Units (ICU), able to identify causes of hemodynamic instability and to quickly guide therapy.Some of its advantages are being a noninvasive method, risk-free, capable of being performed serially and in real time, and analyzed along with clinical data by intensivists.[2] Several studies have demonstrated the positive effect of the use of echocardiography in the management of critically ill patients, changing their treatment in 30%–60% of cases after the test is performed.[3] Scoring systems are arrived at evaluation of the patient’s mortality risk in the ICU by assigning a score to patient and predicting the outcome.[4,5,6] there is need for effective scoring system from the one in which they were originally developed. This study was aimed to evaluate the feasibility of addition of echocardiographic parameters to paediatric version of SOFA score (pSOFA-E score) and to adapt and validate with reference to pSOFA score in predicting the mortality of critically ill children. Conclusion: The findings of the present study validate and emphasize that, addition of score devised by requirement of ionotropes to maintain adequate ejection fraction defy simple bedside echocardiography to pSOFA score is highly useful and accurate in discrimination of PICU mortality, morbidity and cardiovascular status/ compromise of body
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