A Novel Situational Awareness Scoring System in Pediatric Cardiac Intensive Care Unit Patients

Area of Science:

• Pediatric Critical Care Medicine
• Clinical Performance Measurement
• Patient Safety

Background:

• Cardiac arrest (CA) in pediatric cardiac intensive care units (PCICUs) presents significant challenges.
• Early identification of patients at risk for CA is crucial for timely intervention.
• Existing methods for predicting CA may lack sufficient accuracy or timeliness.

Purpose of the Study:

• To evaluate the performance of a novel Situational Awareness Scoring System (SASS) in distinguishing between patients who experienced CA and those who did not within a PCICU.
• To determine the optimal time window for SASS scoring to predict CA.
• To assess the sensitivity and specificity of SASS in identifying patients at high risk for CA.

Main Methods:

• Retrospective observational cohort study in a quaternary-care PCICU.
• Included patients who experienced CA between 2014-2018 and non-CA patients admitted in 2018.
• Utilized cross-validated logistic regression models to calculate Area Under the ROC Curve (AUC) for SASS scores within various time intervals preceding CA.

Main Results:

• The maximum SASS score within a 4-hour interval before CA achieved the highest AUC of 0.91, indicating strong discriminatory performance.
• A SASS score cutoff of 60 within 4 hours demonstrated 82.1% sensitivity and 83.2% specificity for CA prediction.
• Each 10-unit increase in the maximum SASS score within 4 hours was associated with a 1.32-fold increased odds of CA.

Conclusions:

• The novel SASS demonstrates promising performance in discriminating patients at risk for CA in the PCICU.
• The 4-hour time interval prior to CA appears to be the most effective window for SASS application.
• SASS has the potential to serve as a valuable tool for early CA detection and prevention in pediatric critical care settings.