Does pSOFA in the PED Predict Mortality?

June 23, 2022

Written by Clay Smith

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The pSOFA score was not a good screening tool for predicting in-hospital mortality when used in a pediatric emergency department (PED) setting.

Why does this matter?
We know pSOFA is a good predictor of mortality in critically ill children, but how does it perform as a screening tool in the PED?

A blunt instrument
This was a large, retrospective study using the PECARN registry, with almost 4 million patients. Using a pSOFA score cutoff of ≥2, sensitivity was 65% for predicting in-hospital mortality among all-comers and 71% among those with suspected infection (overall AUCs were very similar). Scores ≥2 were rare, with a prevalence of just 3.2%. On the other hand, children with scores <2 had a very low probability of in-hospital mortality. Part of the reason pSOFA might not work as well in the PED as in the PICU is that overall mortality rate in this cohort was very low (0.03%) compared to a PICU cohort (2.6%). Also, pSOFA includes treatments (such as vasoactive drips) and labs (platelet count or bilirubin), and these may not yet have been started or resulted while still in the PED and would have been missed in this registry. Also, in the subset of patients with suspected infection, sepsis, or septic shock, lactate was often not performed and data had to be imputed as normal. The gist of this study is that the pSOFA isn’t the best as a screening tool in the PED for in-hospital mortality. An alternative score for the PED is needed, and studies are in process to do just that.

Source
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 Pediatr. 2022 May 16. doi: 10.1001/jamapediatrics.2022.1301. Online ahead of print.