Performance of the Mean, Highest, and Admission Day Pediatric Sequential Organ Failure Assessment (pSOFA) Scores as Outcome Predictors in a Pediatric Intensive Care Unit: A Prospective Observational Study

Objectives: The Pediatric Sequential Organ Failure Assessment score (pSOFA) has been recently validated from its adult version having included the six clinical and biochemical parameters of organ dysfunction (respiratory, coagulation, cardiovascular, neurological, hepatic, and renal) and adapting age-adjusted cutoffs. Our goal was to find out which among the pSOFA scores (recorded on admission, highest score, and the mean score i.e., pSOFA1, pSOFAh, and pSOFAm respectively) performed better to predict mortality among the patients admitted in our pediatric intensive care unit (PICU). Methods: This prospective observational study was conducted on 104 patients (1 month to 12 years of age) admitted in the eight-bedded PICU of a tertiary care hospital in India who met the inclusion criteria. The highest values of serial pSOFA scores were recorded on every alternate day starting from the day of admission up to day 9. Results: The mean and median values of the pSOFA1, pSOFAm, and pSOFAh were higher in the non-survivor group than the survivors. The mean pSOFA [with a diagnostic accuracy of 92.3% at a mean cut-off value of 12.8] has outperformed the other two pSOFA scores. Conclusions: In this exploratory analysis, the pSOFAm is the best tool in predicting the mortality outcome of any critically ill child. The use of pSOFA score at admission and the mean values helps the clinician to quantify the organ dysfunction and it may be helpful for the clinicians to take steps for further management. It may be useful to communicate to the parents of the sick child for prognostication too. The pSOFA1 also reflects well about the early prognostication when multiple pSOFA scores are unavailable. In the resource-constrained settings, one may rely on the pSOFA1 and the approximate pSOFAm value may be predicted from the pSOFA1 as [pSOFAm = (1.03 x pSOFA1) – 0.9] within limitations.