Matics TJ, et al. - The purpose of this research was to adapt and validate a pediatric version of the Sequential Organ Failure Assessment (SOFA) score (pSOFA) in critically ill children. Additionally, the authors gauged the Sepsis-3 definitions in patients with confirmed or suspected infection. Based on the results it was inferred that the use of these definitions in children was feasible. It illustrated promising results.

Methods

• All critically ill children 21 years or younger admitted to a 20-bed, multidisciplinary, tertiary pediatric intensive care unit between January 1, 2009 and August 1, 2016 were included in this retrospective observational cohort study.
• Data was extracted from an electronic health record database.
• Herein, the pSOFA score was developed by adapting the original SOFA score with age-adjusted cutoffs for the cardiovascular and renal systems and by expanding the respiratory criteria for the inclusion of noninvasive surrogates of lung injury.
• An estimation was carried out of the daily pSOFA scores from admission until day 28 of hospitalization, discharge, or death (whichever came first).
• Three additional pediatric organ dysfunction scores underwent estimation for comparison.
• As a part of the exposure, organ dysfunction was determined via the pSOFA score, and sepsis and septic shock based on the Sepsis-3 definitions.
• The primary outcome was in-hospital mortality.
• A comparative analysis was conducted of the daily pSOFA scores and additional pediatric organ dysfunction scores.
• Performance was assessed through the area under the curve.
• The Sepsis-3 definitions in the subgroup of children with confirmed or suspected infection was discerned via the pSOFA score.

Results

• The inclusion criteria was met by 6,303 patients with 8,711 encounters.
• Each encounter underwent independent treatment.
• Amongst the 8,482 survivors of hospital encounters, 4,644 (54.7%) were male and the median (interquartile range [IQR]) age was 69 (17-156) months.
• Herein, 127 (55.4%) were male with a median (IQR) age of 43 (8-144) months, among the 229 nonsurvivors.
• In-hospital mortality was reported to be 2.6%.
• Excellent discrimination was disclosed by the maximum pSOFA score for in-hospital mortality, with an area under the curve of 0.94 (95% CI, 0.92-0.95).
• The pSOFA score illustrated a similar or better performance than other pediatric organ dysfunction scores.
• On the basis of the Sepsis-3 definitions, 1,231 patients (14.1%) were classified as having sepsis and displayed a mortality rate of 12.1%, and 347 (4.0%) had septic shock and a mortality rate of 32.3%.
• Patients with sepsis exhibited a greater tendency for death than patients with confirmed or suspected infection but no sepsis (odds ratio, 18; 95% CI, 11-28).
• Of the 229 patients who died during their hospitalization, 149 (65.0%) presented with sepsis or septic shock during their course.