Measuring Organ Failure Among Critically Ill Children

May 16, 2018

Article Citation

Matics TJ, Sanchez-Pinto N. 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. doi:10.1001/jamapediatrics.2017.2352.

First Dose

In evaluations of sepsis and septic shock, the Sequential Organ Failure Assessment (SOFA) score has been recommended for quantifying organ dysfunction. The SOFA was developed for adults and includes measures that vary with age, so the authors adapted and validated a pediatric version (pSOFA) using age-adjusted criteria and data from a tertiary care pediatric intensive care unit (PICU) in which 2.6% of 6303 patients died overall. Overall, pSOFA scores had similar or better performance than other organ dysfunction scores, and significantly better performance than SOFA scores, for predicting mortality.

Key Points to Remember

Infographic Comparing pSOFA vs SOFA SubscoresTo adapt SOFA to pSOFA, the authors modified original SOFA cutoffs for renal and cardiovascular variables, expanded the respiratory measure, and used the pediatric version of the Glasgow Coma Scale. In addition to comparing pSOFA to SOFA, the authors compared pSOFA to PELOD, updated PELOD-2, P-MODS, and (on the day of admission only) the PRISM III. Of 8711 PICU encounters, 48.4% had a confirmed or suspected infection. Nonsurvivors had a significantly higher median maximum pSOFA score (13; interquartile range 10-16) than did the survivors (2; 1-5); the optimal maximum pSOFA score to distinguish nonsurvivors versus survivors was 8. The performance of pSOFA on the day of admission was better than the other organ dysfunction scores and similar to PRISM III. In comparisons of scores on "landmark" days during PICU stays, pSOFA performed slightly better on days 2 and 4 and similar to other scores on days 7 and 14. Compared to SOFA subscale scores, pSOFA performed better on cardiovascular, renal, and respiratory subscales.

Link to Research Article

https://jamanetwork.com/journals/jamapediatrics/fullarticle/2646857

Summary Author

Matthew M. Davis, MD, MAPP 

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