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Association of Organ Dysfunction Scores and Functional Outcomes Following Pediatric Critical Illness
Travis J Matics1,2, Neethi P Pinto1, L Nelson Sanchez-Pinto3,4
1Department of Pediatrics, The University of Chicago, Chicago, IL.
Insights
Pediatric organ dysfunction scores, like the pediatric Sequential Organ Failure Assessment and Pediatric Logistic Organ Dysfunction-2, effectively predict long-term functional outcomes and new morbidity in critically ill children. These scores aid in prognostication for children after intensive care.
Area of Science:
- Pediatric critical care medicine
- Outcomes research
- Pediatric intensive care
Background:
- Pediatric critical illness frequently leads to short- and long-term morbidity and mortality.
- Severe organ dysfunction in critically ill children is linked to in-hospital mortality.
- The predictive value of pediatric organ dysfunction scores for long-term functional outcomes remains under-assessed.
Purpose of the Study:
- To evaluate the performance of pediatric organ dysfunction scores in predicting functional outcomes after critical illness.
- To assess the association between organ dysfunction severity and longitudinal changes in functional status.
- To determine the utility of these scores for predicting new morbidity and mortality up to three years post-discharge.
Main Methods:
- Secondary analysis of a prospective observational cohort from a tertiary academic pediatric intensive care unit.
- Calculation of maximum pediatric Sequential Organ Failure Assessment (pSOFA) and Pediatric Logistic Organ Dysfunction-2 (PLOD-2) scores during admission.
- Assessment of Functional Status Scale (FSS) at baseline, 6 months, and 3 years post-discharge; new morbidity defined as FSS change >= 3 points.
Main Results:
- Seventy-three pediatric patients met inclusion criteria; 14% experienced new morbidity or mortality at 6 months, and 23% at 3 years.
- pSOFA and PLOD-2 scores demonstrated excellent discrimination for new morbidity/mortality at 6 months (AUCs 0.90 and 0.88).
- These scores showed good discrimination at 3 years (AUCs 0.82 and 0.79), indicating sustained predictive power.
Conclusions:
- Severity of organ dysfunction correlates with long-term functional status changes and morbidity/mortality.
- Maximum pSOFA and PLOD-2 scores are valuable predictors of new morbidity and mortality up to 3 years post-critical illness.
- These pediatric organ dysfunction scores can aid in prognostication for longitudinal functional outcomes in critically ill children.
Objectives:
Short-term and long-term morbidity and mortality are common following pediatric critical illness. Severe organ dysfunction is associated with significant in-hospital mortality in critically ill children; however, the performance of pediatric organ dysfunction scores as predictors of functional outcomes after critical illness has not been previously assessed.
Design:
Secondary analysis of a prospective observational cohort.
Setting:
A multidisciplinary, tertiary, academic PICU.
Patients:
Patients less than or equal to 18 years old admitted between June 2012 and August 2012.
Interventions:
None.
Measurements And Main Results:
The maximum pediatric Sequential Organ Failure Assessment and Pediatric Logistic Organ Dysfunction-2 scores during admission were calculated. The Functional Status Scale score was obtained at baseline, 6 months and 3 years following discharge. New morbidity was defined as a change in Functional Status Scale greater than or equal to 3 points from baseline. The performance of organ dysfunction scores at discriminating new morbidity or mortality at 6 months and 3 years was measured using the area under the curve. Seventy-three patients met inclusion criteria. Fourteen percent had new morbidity or mortality at 6 months and 23% at 3 years. The performance of the maximum pediatric Sequential Organ Failure Assessment and Pediatric Logistic Organ Dysfunction-2 scores at discriminating new morbidity or mortality was excellent at 6 months (areas under the curves 0.9 and 0.88, respectively) and good at 3 years (0.82 and 0.79, respectively).
Conclusions:
Severity of organ dysfunction is associated with longitudinal change in functional status and short-term and long-term development of new morbidity and mortality. Maximum pediatric Sequential Organ Failure Assessment and Pediatric Logistic Organ Dysfunction-2 scores during critical illness have good to excellent performance at predicting new morbidity or mortality up to 3 years after critical illness. Use of these pediatric organ dysfunction scores may be helpful for prognostication of longitudinal functional outcomes in critically ill children.
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