Paediatric Hepatology Dependency score (PHD score): an audit tool

Area of Science:

• Pediatric Hepatology
• Clinical Assessment Tools
• Disease Severity Measurement

Background:

• Developing a reliable tool to assess patient dependency and disease severity in pediatric liver disease is crucial.
• Existing methods may not adequately capture the spectrum of illness in children with mild to severe liver conditions.

Purpose of the Study:

• To develop and validate a novel scoring system for measuring patient dependency and disease severity in pediatric liver disease.
• To create a tool that is convenient and applicable to a heterogeneous group of pediatric patients with liver conditions.

Main Methods:

• A 10-parameter score was developed, incorporating markers like liver enzymes, albumin, bilirubin, ascites, nutritional support, organ dysfunction, blood product use, sepsis, and IV access.
• The score underwent rigorous statistical validation, including assessments of face validity, internal consistency (Cronbach's alpha), interobserver agreement, and construct validity.
• The score's predictive value was tested against endpoints such as survival and liver transplantation within 6 months.

Main Results:

• The final 10-variable Paediatric Hepatology Dependency score demonstrated good internal consistency (Cronbach's alpha = 0.72).
• The score effectively paralleled clinical deterioration and response to treatment.
• A score >15 significantly predicted death or transplantation (odds ratio 7, P=0.0125) and showed good agreement with the pediatric end-stage liver disease score (r=0.660, P<0.05).

Conclusions:

• The Paediatric Hepatology Dependency score is a valid, internally consistent, and practical tool for assessing disease severity in children with liver disease.
• This score facilitates auditing of hospital admissions and monitoring of patient progress.
• The tool is valuable for comparing patient cohorts across different time periods and interventions.