Scoring system to assess disease severity in children

Area of Science:

• Pediatrics
• Critical Care Medicine
• Medical Informatics

Background:

• Assessing disease severity in pediatric intensive care units (PICUs) is crucial for patient management and resource allocation.
• Existing scoring systems may not fully capture the impact of therapeutic and diagnostic interventions on outcomes.

Purpose of the Study:

• To develop and validate a novel scoring system, the Pediatric Therapeutic and Diagnostic Intervention Score (PTDIS), for assessing disease severity in PICU patients.
• To correlate the PTDIS with patient mortality and identify key interventions associated with adverse outcomes.

Main Methods:

• Retrospective chart review of 475 consecutive pediatric admissions to a multidisciplinary PICU.
• Identification and scoring of therapeutic and diagnostic interventions (TDI) based on their association with mortality.
• Calculation of the PTDIS for each patient and correlation with mortality, sex, age, and hospitalization duration.

Main Results:

• The PTDIS effectively stratified patients into severity groups with distinct mortality rates (e.g., >50% mortality for PTDIS > 36).
• A strong positive correlation was found between PTDIS and mortality (R = 0.7162, p < 0.0001).
• PTDIS was significantly higher in non-survivors (43.6) compared to survivors (15.2).
• Sepsis, CNS infections, burns, shock, coma, and post-resuscitation were associated with highest mortality and PTDIS.

Conclusions:

• The Pediatric Therapeutic and Diagnostic Intervention Score (PTDIS) is an effective tool for accurately assessing disease severity in PICU patients.
• PTDIS provides a valuable metric for predicting mortality risk and guiding clinical care in critically ill children.
• The system's focus on interventions offers a unique perspective on disease severity assessment.