Evaluation of pediatric intensive care scoring systems
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1General Intensive Care Unit, Hospitals for Sick Children, London, UK.
Insights
Pediatric severity scoring systems like APSI and OSF show promise but need improvement for UK ICUs. A simpler, comprehensive system is needed to compare pediatric intensive care outcomes globally.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Biostatistics
Background:
- No prior analysis of pediatric severity scoring systems in UK Intensive Care Units (ICUs).
- Existing systems like Admission Physiologic Stability Index (APSI) and Organ System Failure (OSF) score require evaluation for pediatric populations.
Purpose of the Study:
- To evaluate the effectiveness of the APSI and OSF scores in a British pediatric ICU cohort.
- To identify limitations of current scoring systems in predicting mortality and comparing outcomes.
Main Methods:
- Retrospective analysis of 151 pediatric patients admitted to ICUs.
- Evaluation of Admission Physiologic Stability Index (APSI) and Organ System Failure (OSF) scores.
- Statistical comparison of scores between survivors and non-survivors, and by length of ICU stay.
Main Results:
- APSI scores were significantly higher in non-survivors compared to survivors (p < 0.001).
- APSI effectively distinguished between children with short (<24h) versus long (>24h) ICU stays but showed overlap for longer stays.
- Both APSI and OSF scores underestimated severity in neurological patients; OSF correlated with mortality, but timing of organ failure did not impact mortality rates.
Conclusions:
- Current pediatric severity scoring systems have limitations, particularly for neurological cases and long-stay patients.
- There is a critical need for a more comprehensive and simpler pediatric scoring system for international comparison of pediatric intensive care efficacy and outcomes.
Abstract:
There is no report analysing pediatric severity scoring systems in British Intensive Therapy Units (ICUs). Two previously reported pediatric severity scoring systems, the Admission Physiologic Stability Index (APSI) and the Organ System Failure (OSF) score were evaluated for 151 patients. The APSI was higher for children who died than for those who lived (p less than 0.001). This difference reflected the sharp distinction between the APSI for children who left intensive care within 24 h and those remaining in ICU longer than 24 h (p less than 0.001). For children remaining in ICU longer than 24 h, there was a large overlap of APSI scores, and the APSI did not discriminate between children in the overlap region who lived and those who died (p = 0.054). There was underscoring of neurological patients; the APSI did not differentiate neurological patients whole lived and those who died (p greater than 0.10). The OSF also underscored neurological patients. Increasing number of organ systems failed was associated with increasing mortality. In contrast to previous reports, however, the mortality rate was unaffected by whether the total number of systems failed simultaneously or non-simultaneously. There is still a need for a comprehensive yet simple pediatric scoring system for comparing the efficacy and outcome of pediatric intensive care in different ICUs in different countries.