Badke Colleen M, Wang Austin, Daniels Latasha A, Sanchez-Pinto L Nelson
Division of Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Stanley Manne Children's Research Institute, Chicago, IL, USA.
J Intensive Care Med. 2025 May;40(5):565-570. doi: 10.1177/08850666241307630. Epub 2025 Jan 9.
Objective: To determine the prognostic value of the Pediatric Sequential Organ Failure Assessment (pSOFA) to discriminate critical events, including code events and intubations, in the pediatric intensive care unit (PICU). Methods: We performed an observational cohort study of all critical events in a quaternary care PICU between 5/2020 and 4/2023. Critical events were extracted from our hospital communications platform and from the electronic health record (EHR). The pediatric sequential organ failure assessment (pSOFA) scores were prospectively calculated in real-time in our EHR every 15 min during the study period for data-driven situational awareness and were retrospectively analyzed for this study. Each encounter was divided into 6-h time blocks and we assessed the performance of the highest pSOFA score in each block at discriminating the occurrence of a critical event in the subsequent block. Results:There were 5687 unique patient encounters included in the analysis. Critical events were identified in 578 out of 169 486 time blocks (prevalence 0.3%), which included 103 code events and 498 intubation events, in 392 unique PICU encounters. The total pSOFA score in a 6-h time block was significantly associated with a subsequent code event (odds ratio [OR] 1.19, 95% CI 1.13-1.24) or intubation (OR 1.13, 95% CI 1.10-1.15). Several organ-specific pSOFA subscores were also significantly associated with the outcomes. Area under the receiver operating characteristic curve (AUROC) for the total pSOFA score was 0.67 for a code event and 0.65 for intubation. Using a pSOFA score cutoff of ≥8, the positive predictive value was 0.8% and the negative predictive value was 99.7% for any critical event. Conclusions: The pSOFA score is significantly associated with critical events in the PICU, however, it does not have adequate performance to be used for situational awareness by itself.
确定儿童序贯器官衰竭评估（pSOFA）对区分儿科重症监护病房（PICU）中的危急事件（包括抢救事件和插管）的预后价值。方法：我们对2020年5月至2023年4月期间一家四级医疗PICU中的所有危急事件进行了一项观察性队列研究。危急事件从我们医院的通信平台和电子健康记录（EHR）中提取。在研究期间，每15分钟在我们的EHR中前瞻性地实时计算儿童序贯器官衰竭评估（pSOFA）评分，以实现数据驱动的态势感知，并对本研究进行回顾性分析。每次就诊分为6小时时间段，我们评估每个时间段内最高pSOFA评分在区分后续时间段内危急事件发生情况方面的表现。结果：分析纳入了5687例独特的患者就诊情况。在169486个时间段中有578个（患病率0.3%）确定了危急事件，其中包括392例独特的PICU就诊中的103例抢救事件和498例插管事件。6小时时间段内的总pSOFA评分与随后的抢救事件（比值比[OR]1.19，95%置信区间1.13 - 1.24）或插管（OR 1.13，95%置信区间1.10 - 1.15）显著相关。几个器官特异性的pSOFA子评分也与结局显著相关。总pSOFA评分的受试者工作特征曲线下面积（AUROC）对于抢救事件为0.67，对于插管为0.65。使用pSOFA评分≥8的截断值，对于任何危急事件，阳性预测值为0.8%，阴性预测值为99.7%。结论：pSOFA评分与PICU中的危急事件显著相关，然而，其本身用于态势感知的性能并不充分。
