Assessing the accuracy of prognostic scales in children with neuroinfections

Abstract

Accurate assessment of the disease severity and outcome prediction in children with neuroinfections is one of the most challenging problems in pediatric intensive care. Objective. To evaluate performance characteristics of several prognostic scales used in children with infections of the central nervous system (CNS). Patients and methods. We examined 100 children with a mean age of 3.5 years. Mean length of stay in the intensive care unit was 9.5 days; mean duration of ventilation was 6.0 days. The death rate was 11%. To evaluate patients’ condition, we used the following scales: PELOD2, PELOD, PRISM3, and pSOFA. Results. We found that 65% of patients had depressed consciousness; 22% of patients had high-grade fever. The stroke volume and ejection fraction were near the lower reference limit, while 20% of children had their ejection fraction ≤ 60%. Leukocytosis was observed in 51 children; 37 children had anemia. Hyponatremia was registered in 17% of cases. Severe hypocoagulation was observed in 7% of cases in patients with generalized meningococcal infection. We found that thrombocytopenia (117 × 109 cells/L) and SpO2/FiO2 ratio <200 mm Hg were the main predictors of death. The рSOFA scale demonstrated the highest accuracy among the scales studied (AUC = 0.717). Conclusion. The рSOFA scale is a highly sensitive and specific scale for the assessment of death risk in children with CNS infections, which allows us to recommend it for routine clinical practice. Key words: CNS infections, children, prognostic scales, PELOD, PELOD-2, рSOFA, SOFA