Colleen M Badke, Austin Wang, Latasha A Daniels, L Nelson Sanchez-Pinto
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引用次数: 0
Abstract
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.
目的：确定儿童序贯器官衰竭评估（pSOFA）在儿科重症监护病房（PICU）中区分关键事件（包括代码事件和插管）的预后价值。方法：我们在2020年5月至2023年4月期间进行了一项观察性队列研究，研究了第四期护理PICU的所有关键事件。从我们的医院通信平台和电子健康记录（EHR）中提取关键事件。在研究期间，我们每隔15分钟在电子病历中前瞻性地实时计算儿童顺序器官衰竭评估（pSOFA）评分，以获得数据驱动的态势感知，并对该研究进行回顾性分析。每次遭遇被划分为6小时的时间段，我们评估了每个时间段中最高pSOFA评分的表现，以区分随后时间段中关键事件的发生。结果：有5687例独特的患者遭遇纳入分析。在169 486个时间块中，有578个确定了关键事件（患病率0.3%），其中包括392次PICU独特就诊中的103个编码事件和498个插管事件。6小时内的pSOFA总评分与随后的编码事件（比值比[OR] 1.19, 95% CI 1.13-1.24）或插管（OR 1.13, 95% CI 1.10-1.15）显著相关。几个器官特异性pSOFA评分也与结果显著相关。受试者工作特征曲线下面积（AUROC）的总pSOFA评分为0.67编码事件和0.65插管。采用≥8分的pSOFA评分截止值，任何关键事件的阳性预测值为0.8%，阴性预测值为99.7%。结论：pSOFA评分与PICU中的关键事件显著相关，然而，它本身没有足够的性能用于态势感知。
期刊介绍：
Journal of Intensive Care Medicine (JIC) is a peer-reviewed bi-monthly journal offering medical and surgical clinicians in adult and pediatric intensive care state-of-the-art, broad-based analytic reviews and updates, original articles, reports of large clinical series, techniques and procedures, topic-specific electronic resources, book reviews, and editorials on all aspects of intensive/critical/coronary care.
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