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Predicting death in pediatric patients with acute respiratory failure. Pediatric Critical Care Study Group.
O D Timmons1, P L Havens, J C Fackler
1University of Utah School of Medicine, Salt Lake City, USA.
Insights
The Pediatric Respiratory Failure (PeRF) score accurately estimates mortality risk in critically ill children with acute hypoxemic respiratory failure (AHRF). This tool can aid future research on pediatric AHRF treatments.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Clinical Epidemiology
Background:
- Acute hypoxemic respiratory failure (AHRF) presents a significant mortality risk in pediatric intensive care units (PICUs).
- Accurate estimation of mortality risk is crucial for managing high-risk pediatric patients and evaluating novel therapeutic interventions.
Purpose of the Study:
- To develop and validate a clinical score for estimating mortality risk in pediatric patients diagnosed with AHRF.
- To identify key variables associated with mortality in this patient population.
Main Methods:
- A retrospective chart review was conducted across 41 pediatric ICUs, analyzing data from 470 children with AHRF.
- Logistic regression was used to develop the Pediatric Respiratory Failure (PeRF) score, incorporating variables like age, oxygen requirements, and ventilatory parameters.
- The score's predictive performance was evaluated using receiver operating characteristic (ROC) curves and goodness-of-fit tests in a separate validation cohort.
Main Results:
- The overall mortality rate in the study cohort was 43%.
- The PeRF score, comprising 10 clinical variables, demonstrated good predictive accuracy, with the area under the ROC curve exceeding 0.8 after 36 hours.
- The score showed no significant difference between estimated and actual mortality in the validation subset for the first 96 hours of treatment.
Conclusions:
- The PeRF Score provides an accurate estimation of mortality risk for high-risk pediatric patients with AHRF.
- This validated score can serve as a valuable tool in clinical research for assessing new treatments for pediatric AHRF.
- Prospective validation is recommended before clinical implementation for patient management decisions.
Objective:
To estimate mortality risk in pediatric patients with acute hypoxemic respiratory failure (AHRF).
Design:
Retrospective chart review.
Setting:
Forty-one pediatric ICUs.
Subjects:
Four hundred seventy children with AHRF. We defined AHRF as mechanical ventilation with positive end-expiratory pressure > or = 6 cm H2O and fraction of inspired oxygen greater than or equal to 0.5 for 12 or more hours.
Measurements:
Physiologic and treatment variables were recorded every 12 h for 14 days. Cases were randomly assigned to score development and score validation subsets. Variables were assessed for their association with mortality in the development subset by logistic regression analysis. The analysis generated a series of logistic equations, which we called the Pediatric Respiratory Failure (PeRF) score, to estimate mortality risk at 12-h intervals over the first 7 days of treatment for AHRF. The predictive ability of the score was assessed in the validation subset by receiver operating characteristic curve area and goodness-of-fit chi 2.
Results:
Mortality of the collected cases was 43%. The PeRF score included age, operative status, Pediatric Risk of Mortality score, fraction of inspired oxygen, respiratory rate, peak inspiratory pressure, positive end-expiratory pressure, PaO2, and PaCO2. Area under the receiver operating characteristic curve was 0.769 at entry and increased to greater than 0.8 after 36 h. When the score was applied to the validation subset of patients, goodness-of-fit chi 2 showed no significant difference between estimated and actual mortality between 0 and 96 h.
Conclusions:
The PeRF Score accurately estimated mortality risk in this retrospectively sampled group of high-risk pediatric patients with AHRF. This score may be useful in studies of newer therapies for pediatric AHRF, though prospective validation is necessary before it could be used to make clinical decisions.