Severity of illness and organ dysfunction scoring systems in pediatric critical care: The impacts on clinician's practices and the future

Morgan Recher; Stéphane Leteurtre; Valentine Canon; Jean Benoit Baudelet; Marguerite Lockhart; Hervé Hubert

doi:10.3389/fped.2022.1054452

Severity of illness and organ dysfunction scoring systems in pediatric critical care: The impacts on clinician's practices and the future

Front Pediatr. 2022 Nov 22:10:1054452. doi: 10.3389/fped.2022.1054452. eCollection 2022.

Authors

Morgan Recher^{1

2}, Stéphane Leteurtre^{1

2}, Valentine Canon^{1

2}, Jean Benoit Baudelet¹, Marguerite Lockhart^{1

2}, Hervé Hubert^{1

2}

Affiliations

¹ University of Lille, Centre Hospitalier Universitaire de Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France.
² French National Out-of-Hospital Cardiac Arrest Registry, Lille, France.

Abstract

Severity and organ dysfunction (OD) scores are increasingly used in pediatric intensive care units (PICU). Therefore, this review aims to provide 1/ an updated state-of-the-art of severity scoring systems and OD scores in pediatric critical care, which explains 2/ the performance measurement tools and the significance of each tool in clinical practice and provides 3/ the usefulness, limits, and impact on future scores in PICU. The following two pediatric systems have been proposed: the PRISMIV, is used to collect data between 2 h before PICU admission and the first 4 h after PICU admission; the PIM3, is used to collect data during the first hour after PICU admission. The PELOD-2 and SOFApediatric scores were the most common OD scores available. Scores used in the PICU should help clinicians answer the following three questions: 1/ Are the most severely ill patients dying in my service: a good discrimination allow us to interpret that there are the most severe patients who died in my service. 2/ Does the overall number of deaths observed in my department consistent with the severity of patients? The standard mortality ratio allow us to determine whether the total number of deaths observed in our service over a given period is in adequacy with the number of deaths predicted, by considering the severity of patients on admission? 3/ Does the number of deaths observed by severity level in my department consistent with the severity of patients? The calibration enabled us to determine whether the number of deaths observed according to the severity of patients at PICU admission in a department over a given period is in adequacy with the number of deaths predicted, according to the severity of the patients at PICU admission. These scoring systems are not interpretable at the patient level. Scoring systems are used to describe patients with PICU in research and evaluate the service's case mix and performance. Therefore, the prospect of automated data collection, which permits their calculation, facilitated by the computerization of services, is a necessity that manufacturers should consider.

Keywords: PICU; evaluation; organ dysfunction; scoring system; severity score.

Publication types

Review