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Application of modified sequential organ failure assessment score in children after cardiac surgery
N Shime1, K Kageyama, H Ashida
1Pediatric Intensive Care Unit and Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kyoto, Japan. shime@koto.kpu-m.ac.jp
Objective:
To evaluate the usefulness of the modified sequential organ failure assessment (m/SOFA) score for assessing morbidity and mortality in pediatric patients after cardiac surgery.
Design:
Analysis of a prospectively collected database.
Setting:
Pediatric intensive care unit of a university-affiliated hospital.
Participants:
Consecutive pediatric patients (n = 142) undergoing cardiac surgery.
Interventions:
None.
Measurements And Main Results:
The m/SOFA score, consisting of 5 organ scores (maximum score of 20 points), was calculated on admission (initial) and at 12 and 36 hours postoperatively. An initial score of >5 points with an unchanged or upward postoperative trend predicted a higher postoperative mortality and a greater need for intensive care intervention. In neonates, sustained higher score >10 points predicted an outcome of death with a sensitivity of 100% and a specificity of 87%. Given the higher mortality related to immature organ function and a greater complexity of heart defects, the application of the m/SOFA score, a less invasive and simple way to assess organ damage, is especially suitable in neonates. The m/SOFA score would be more appropriately assessed according to the congenital heart defect or surgical procedure because the types of cardiac defect after the surgical repair affect each organ score measurement.
Conclusion:
Application of the m/SOFA score in the early postoperative period, which reflects cumulative perioperative organ damage, would provide some direction to eventual outcomes of morbidity and mortality in patients with congenital heart defects undergoing surgery.