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Comparing Vasoactive-Inotropic Score Reporting Strategies in the PICU Relative to Mortality Risk
Matthew A Musick1, Laura L Loftis, Curtis E Kennedy
1All authors: Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Insights
High Vasoactive-Inotropic Scores predict mortality risk in pediatric intensive care units (PICUs). The method of calculating these scores impacts their association with outcomes, highlighting the need for standardized approaches in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Pharmacology
- Outcomes research
Background:
- Vasoactive-Inotropic Scores (VIS) are increasingly used to assess critically ill noncardiac patients.
- Existing studies use varied VIS calculation methods, hindering comparisons.
- Standardization is needed to validate VIS in noncardiac pediatric populations.
Purpose of the Study:
- To compare different Vasoactive-Inotropic Score calculation methods.
- To determine the association of various VIS approaches with mortality in a general pediatric intensive care unit (PICU) population.
- To inform future research on optimal VIS assignment strategies.
Main Methods:
- Retrospective chart review of 474 pediatric patients receiving vasoactive medications.
- Calculation of Vasoactive-Inotropic Scores at each dose change.
- Evaluation of multiple scoring strategies using receiver operating characteristic curves against mortality.
Main Results:
- The maximum Vasoactive-Inotropic Score (Max Any) during initial treatment showed the highest area under the curve (0.788) for predicting mortality.
- VIS at 48 hours also demonstrated strong predictive value (AUC 0.736).
- Predictive accuracy varied by primary diagnosis, with the cardiovascular group showing the highest AUC (0.879).
Conclusions:
- Elevated Vasoactive-Inotropic Scores are linked to increased mortality risk in the PICU.
- The choice of Vasoactive-Inotropic Score calculation strategy influences its predictive power.
- Primary diagnosis impacts the strength of the association between VIS and mortality.
Objectives:
High Vasoactive-Inotropic Scores have demonstrated association with poor outcomes in pediatric cardiac ICUs and are being calculated more frequently in studies of critically ill noncardiac patients. Available studies differ in their approach to assigning Vasoactive-Inotropic Scores, making direct comparisons difficult. The goal of this investigation is to compare multiple approaches to Vasoactive-Inotropic Score assignment to determine their strength of association with mortality in a general pediatric intensive care population. In doing so, we aim to help validate the use of the Vasoactive-Inotropic Score in noncardiac patients and to help inform future studies of the relative strength of available approaches in assigning this score.
Design:
Retrospective chart review.
Setting:
PICU at an academic freestanding children's hospital.
Patients:
Two-thousand seven-hundred fifty-two consecutive patients admitted over a 17-month time period were screened for receiving inotrope or vasopressor therapies regardless of disease process. Four-hundred seventy-four patients met inclusion criteria.
Interventions:
None.
Measurements And Main Results:
For each patient treated with continuous infusions of vasoactive medications, a Vasoactive-Inotropic Score was calculated (and then recalculated) every time they had a documented dose change. Multiple strategies were evaluated to generate receiver operating characteristic curves in relation to mortality. Area under the curve was greatest when evaluating the maximum Vasoactive-Inotropic Score (Max Any) during the initial treatment course (0.788) with an increasing relative risk as the score increased. The Vasoactive-Inotropic Score at 48 hours after treatment initiation had next highest area under the curve (0.736). Primary diagnosis categories were also analyzed, and area under the curve was greatest for the cardiovascular group (0.879).
Conclusions:
Increasing Vasoactive-Inotropic Scores for patients in the PICU are associated with mortality risk. The scoring strategy used can influence the strength of the association, as can the primary diagnosis category.
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