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[Value of three scoring systems in evaluating the prognosis of children with severe sepsis]
Li-Bing Zhou1, Jiao Chen, Xiao-Chen DU
1Department of Critical Care Medicine, Children's Hospital of Soochow University, Suzhou 215000, China. haitaosz@163.com.
Insights
The Pediatric Age-adapted Sequential Organ Failure Assessment Score (pSOFA) better predicts outcomes in children with severe sepsis than the Pediatric Risk of Mortality Score III (PRISM III) and Pediatric Critical Illness Score (PCIS). This study analyzed 193 children to compare scoring system effectiveness.
Area of Science:
- Pediatric critical care medicine
- Sepsis research
- Clinical scoring systems
Background:
- Severe sepsis poses a significant mortality risk in children.
- Accurate prognostic scoring systems are crucial for timely intervention and management.
- Existing scores like PRISM III and PCIS require evaluation against newer metrics like pSOFA.
Purpose of the Study:
- To evaluate and compare the predictive accuracy of pSOFA, PRISM III, and PCIS in children diagnosed with severe sepsis.
- To determine which scoring system offers the most reliable prognosis for pediatric sepsis patients.
- To assess the clinical utility of these scoring systems in guiding treatment decisions.
Main Methods:
- Retrospective analysis of clinical data from 193 pediatric severe sepsis patients.
- Calculation of pSOFA, PRISM III, and PCIS based on worst values within 24 hours of admission.
- Utilized Receiver Operating Characteristic (ROC) curve analysis and Decision Curve Analysis (DCA) to assess predictive performance and clinical application.
Main Results:
- ROC analysis indicated PRISM III had a better predictive value than PCIS (P=0.045).
- PRISM III showed the highest correlation with prognosis, followed by pSOFA and PCIS.
- DCA revealed pSOFA provided the highest standardized net benefit for intervention decisions, outperforming PRISM III and PCIS.
Conclusions:
- All three scoring systems (pSOFA, PRISM III, PCIS) demonstrate value in predicting prognosis for pediatric severe sepsis.
- The pSOFA score exhibits superior predictive capability compared to both PRISM III and PCIS in this patient cohort.
- pSOFA shows greater clinical utility in decision-making for emergency interventions in pediatric severe sepsis.
Objective:
To study the predictive value of Pediatric Age-adapted Sequential Organ Failure Assessment Score (pSOFA), Pediatric Risk of Mortality Score III (PRISM III), and Pediatric Critical Illness Score (PCIS) in children with severe sepsis.
Methods:
A retrospective analysis was performed for the clinical data of 193 hospitalized children with severe sepsis. According to the final outcome, these children were divided into a survival group with 151 children and a death group with 42 children. The scores of pSOFA, PRISM III, and PCIS were determined according to the worst values of each index within 24 hours after admission. The receiver operating characteristic (ROC) curve was used to analyze the efficiency of each scoring system in predicting the risk of death due to sepsis. Smooth curve fitting was used to analyze the correlation between the three scoring systems and the threshold effect of each scoring system. Decision curve analysis (DCA) was used to evaluate the application value of each scoring system.
Results:
The ROC analysis showed that PCIS and pSOFA had a similar predictive value (P=0.182) and that PRISM III and pSOFA had a similar predictive value (P=0.210), while PRISM III had a better predictive value than PCIS (P=0.045). PRISM III had the highest degree of fitting with prognosis, followed by pSOFA and PCIS. The DCA analysis showed that when the risk of death was 0.4 and 0.6 in children with severe sepsis and the three scoring systems were used as the basis for emergency intervention decision-making, pSOFA achieved the highest standardized net benefit, followed by PRISM III and PCIS.
Conclusions:
All three scoring systems have a certain value in predicting the prognosis of children with severe sepsis, and pSOFA has a better value than PRISM III and PCIS.
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