Pediatric Simplified Acute Physiology Score II: Establishment of a New, Repeatable Pediatric Mortality Risk
Stefan Irschik1, Jelena Veljkovic2, Johann Golej1
1Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria.
Insights
The new pediatric Simplified Acute Physiology Score II (p-SAPS II) shows improved mortality risk prediction in pediatric intensive care units compared to established scores. While accurate, further calibration is needed for earlier prediction.
Area of Science:
- Critical Care Medicine
- Pediatric Health
- Medical Scoring Systems
Background:
- Accurate mortality risk assessment is vital in pediatric critical care.
- Established scoring systems require evaluation for improved accuracy and repeatability.
- The pediatric Simplified Acute Physiology Score II (p-SAPS II) is a novel, age-adapted scoring system.
Purpose of the Study:
- To evaluate the performance of the p-SAPS II in predicting mortality risk in pediatric intensive care unit (PICU) patients.
- To compare p-SAPS II against established scores: Pediatric Sequential Organ Failure Assessment Score (pSOFA), Pediatric Logistic Organ Dysfunction Score-2 (PELOD-2), and Pediatric Index of Mortality 3 (PIM3).
- To assess the repeatability and discrimination capabilities of p-SAPS II throughout a patient's PICU stay.
Main Methods:
- Retrospective cohort pilot study including 231 PICU admissions (neonates to 18 years).
- Data collected between July 2017 and December 2018 at the Medical University of Vienna.
- Performance evaluated using Area Under the Receiver Operating Characteristic Curve (AUROC) and goodness-of-fit tests.
Main Results:
- p-SAPS II demonstrated the highest AUROC (0.86), significantly outperforming PELOD-2/pSOFA and showing comparable discrimination to PIM3.
- In logistic regression, p-SAPS II significantly improved prediction accuracy when combined with PIM3.
- p-SAPS II showed increasing AUROC values throughout the PICU stay, exceeding PIM3 in prediction accuracy over time, though it overestimated mortality initially.
Conclusions:
- The p-SAPS II is a promising tool for discriminating between survivors and non-survivors in the PICU, outperforming PIM3.
- Its repeatable assessment throughout the PICU stay enhances mortality prediction accuracy.
- Further calibration of p-SAPS II is necessary to optimize early mortality prediction.
Abstract:
Objectives: In critical care it is crucial to appropriately assess the risk of mortality for each patient. This is especially relevant in pediatrics, with its need for accurate and repeatable scoring. Aim of this study was to evaluate an age-adapted version of the expanded Simplified Acute Physiology Score II; (p-SAPS II), a repeatable, newly-designed scoring system compared to established scores (Pediatric Sequential Organ Failure Assessment Score/pSOFA, Pediatric Logistic Organ Dysfunction Score-2/PELOD-2 and Pediatric Index of Mortality 3/PIM3). Design: This retrospective cohort pilot study included data collected from patients admitted to the Pediatric Intensive Care Unit (PICU) at the Medical University of Vienna between July 2017 through December 2018. Patients: 231 admissions were included, comprising neonates (gestational age of ≥ 37 weeks) and patients up to 18 years of age with a PICU stay longer than 48 h. Main Outcomes: Mortality risk prediction and discrimination between survivors and non-survivors were the main outcomes of this study. The primary statistical methods for evaluating the performance of each score were the area under the receiver operating characteristic curve (AUROC) and goodness-of-fit test. Results: Highest AUROC curve was calculated for p-SAPS II (AUC = 0.86; 95% CI: 0.77-0.96; p < 0.001). This was significantly higher than the AUROCs of PELOD-2/pSOFA but not of PIM3. However, in a logistic regression model including p-SAPS II and PIM3 as covariates, p-SAPS II had a significant effect on the accuracy of prediction (p = 0.003). Nevertheless, according to the goodness-of-fit test for p-SAPS II and PIM3, p-SAPS II overestimated the number of deaths, whereas PIM3 showed acceptable estimations. Repeatability testing showed increasing AUROC values for p-SAPS II throughout the clinical stay (0.96 at day 28) but still no significant difference to PIM 3. The prediction accuracy, although improved over the days and even exceeded PIM 3. Conclusions: The newly-created p-SAPS II performed better than the established PIM3 in terms of discriminating between survivors and non-survivors. Furthermore, p-SAPS II can be assessed repeatably throughout a patient's PICU stay what improves mortality prediction. However, there is still a need to optimize calibration of the score to accurately predict mortality sooner throughout the clinical stay.
