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Validation of the Pediatric Sequential Organ Failure Assessment Score and Evaluation of Third International Consensus Definitions for Sepsis and Septic Shock Definitions in the Pediatric Emergency Department.
JAMA Pediatrics ( IF 26.1 ) Pub Date : 2022-07-01 , DOI: 10.1001/jamapediatrics.2022.1301
Fran Balamuth 1 , Halden F Scott 2 , Scott L Weiss 1 , Michael Webb 3 , James M Chamberlain 4 , Lalit Bajaj 2 , Holly Depinet 5 , Robert W Grundmeier 1 , Diego Campos 1 , Sara J Deakyne Davies 2 , Norma Jean Simon 6 , Lawrence J Cook 3 , Elizabeth R Alpern 6 ,
Affiliation  

Importance Pediatric sepsis definitions have evolved, and some have proposed using the measure used in adults to quantify organ dysfunction, a Sequential Organ Failure Assessment (SOFA) score of 2 or more in the setting of suspected infection. A pediatric adaptation of SOFA (pSOFA) showed excellent discrimination for mortality in critically ill children but has not been evaluated in an emergency department (ED) population. Objective To delineate test characteristics of the pSOFA score for predicting in-hospital mortality among (1) all patients and (2) patients with suspected infection treated in pediatric EDs. Design, Setting, and Participants This retrospective cohort study took place from January 1, 2012, to January 31, 2020 in 9 US children's hospitals included in the Pediatric Emergency Care Applied Research Network (PECARN) Registry. The data was analyzed from February 1, 2020, to April 18, 2022. All ED visits for patients younger than 18 years were included. Exposures ED pSOFA score was assigned by summing maximum pSOFA organ dysfunction components during ED stay (each 0-4 points). In the subset with suspected infection, visit meeting criteria for sepsis (suspected infection with a pSOFA score of 2 or more) and septic shock (suspected infection with vasoactive infusion and serum lactate level >18.0 mg/dL) were identified. Main Outcomes and Measures Test characteristics of pSOFA scores of 2 or more during the ED stay for hospital mortality. Results A total of 3 999 528 (female, 47.3%) ED visits were included. pSOFA scores ranged from 0 to 16, with 126 250 visits (3.2%) having a pSOFA score of 2 or more. pSOFA scores of 2 or more had sensitivity of 0.65 (95% CI, 0.62-0.67) and specificity of 0.97 (95% CI, 0.97-0.97), with negative predictive value of 1.0 (95% CI, 1.00-1.00) in predicting hospital mortality. Of 642 868 patients with suspected infection (16.1%), 42 992 (6.7%) met criteria for sepsis, and 374 (0.1%) met criteria for septic shock. Hospital mortality rates for suspected infection (599 502), sepsis (42 992), and septic shock (374) were 0.0%, 0.9%, and 8.0%, respectively. The pSOFA score had similar discrimination for hospital mortality in all ED visits (area under receiver operating characteristic curve, 0.81; 95% CI, 0.79-0.82) and the subset with suspected infection (area under receiver operating characteristic curve, 0.82; 95% CI, 0.80-0.84). Conclusions and Relevance In a large, multicenter study of pediatric ED visits, a pSOFA score of 2 or more was uncommon and associated with increased hospital mortality yet had poor sensitivity as a screening tool for hospital mortality. Conversely, children with a pSOFA score of 2 or less were at very low risk of death, with high specificity and negative predictive value. Among patients with suspected infection, patients with pSOFA-defined septic shock demonstrated the highest mortality.

中文翻译:

小儿继发性器官衰竭评估评分的验证和小儿急诊科脓毒症和感染性休克定义的第三国际共识定义的评估。

重要性 儿科脓毒症的定义已经演变,一些人提议使用成人中使用的测量来量化器官功能障碍,即在疑似感染的情况下序贯器官衰竭评估 (SOFA) 评分为 2 分或以上。SOFA 的儿科适应症 (pSOFA) 显示出对危重儿童死亡率的极好区分,但尚未在急诊科 (ED) 人群中进行评估。目的 描述 pSOFA 评分的测试特征,用于预测 (1) 所有患者和 (2) 在儿科 ED 治疗的疑似感染患者的院内死亡率。设计、设置和参与者 这项回顾性队列研究于 2012 年 1 月 1 日至 2020 年 1 月 31 日在儿科急救护理应用研究网络 (PECARN) 注册中心包括的 9 家美国儿童医院进行。分析了 2020 年 2 月 1 日至 2022 年 4 月 18 日的数据。包括所有 18 岁以下患者的急诊就诊。暴露 ED pSOFA 评分是通过对 ED 住院期间最大 pSOFA 器官功能障碍成分求和来分配的(每个 0-4 分)。在疑似感染的子集中,确定了满足脓毒症(pSOFA 评分为 2 分或以上的疑似感染)和感染性休克(血管活性输注疑似感染且血清乳酸水平 >18.0 mg/dL)的就诊标准。主要结果和措施 急诊住院期间 pSOFA 得分为 2 或以上的测试特征的住院死亡率。结果 总共包括 3 999 528 次(女性,47.3%)急诊就诊。pSOFA 评分范围为 0 至 16,其中 126 250 次访问 (3.2%) 的 pSOFA 评分为 2 或更高。pSOFA 得分为 2 或更高的灵敏度为 0.65(95% CI,0.62-0. 67) 和特异性为 0.97 (95% CI, 0.97-0.97),预测医院死亡率的阴性预测值为 1.0 (95% CI, 1.00-1.00)。642 868 例疑似感染患者(16.1%)中,42 992 例(6.7%)符合脓毒症标准,374 例(0.1%)符合感染性休克标准。疑似感染(599 502 人)、败血症(42 992 人)和感染性休克(374 人)的住院死亡率分别为 0.0%、0.9% 和 8.0%。pSOFA 评分在所有急诊就诊(接受者操作特征曲线下面积,0.81;95% CI,0.79-0.82)和疑似感染子集(接受者操作特征曲线下面积,0.82;95% CI)中对医院死亡率具有相似的区分能力, 0.80-0.84). 结论和相关性 在一项针对儿科急诊就诊的大型多中心研究中,pSOFA 评分为 2 或更高并不常见,并且与住院死亡率增加相关,但作为住院死亡率筛查工具的敏感性较差。相反,pSOFA 评分为 2 或以下的儿童死亡风险非常低,具有高特异性和阴性预测值。在疑似感染的患者中,pSOFA 定义的感染性休克患者的死亡率最高。
更新日期:2022-05-16
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