Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/119430
Citations
Scopus Web of Science® Altmetric
?
?
Type: Journal article
Title: Prognostic accuracy of age-adapted SOFA, SIRS, PELOD-2, and qSOFA for in-hospital mortality among children with suspected infection admitted to the intensive care unit
Author: Schlapbach, L.
Straney, L.
Bellomo, R.
MacLaren, G.
Pilcher, D.
Citation: Intensive Care Medicine, 2018; 44(2):179-188
Publisher: Springer
Issue Date: 2018
ISSN: 0342-4642
1432-1238
Statement of
Responsibility: 
Luregn J. Schlapbach, Lahn Straney, Rinaldo Bellomo, Graeme MacLaren, David Pilcher
Abstract: PURPOSE:The Sepsis-3 consensus task force defined sepsis as life-threatening organ dysfunction caused by dysregulated host response to infection. However, the clinical criteria for this definition were neither designed for nor validated in children. We validated the performance of SIRS, age-adapted SOFA, quick SOFA and PELOD-2 scores as predictors of outcome in children. METHODS:We performed a multicentre binational cohort study of patients < 18 years admitted with infection to ICUs in Australia and New Zealand. The primary outcome was ICU mortality. SIRS, age-adapted SOFA, quick SOFA and PELOD-2 scores were compared using crude and adjusted area under the receiver operating characteristic curve (AUROC) analysis. RESULTS:Of 2594 paediatric ICU admissions due to infection, 151 (5.8%) children died, and 949/2594 (36.6%) patients died or experienced an ICU length of stay ≥ 3 days. A ≥ 2-point increase in the individual score was associated with a crude mortality increase from 3.1 to 6.8% for SIRS, from 1.9 to 7.6% for age-adapted SOFA, from 1.7 to 7.3% for PELOD-2, and from 3.9 to 8.1% for qSOFA (p < 0.001). The discrimination of outcomes was significantly higher for SOFA (adjusted AUROC 0.829; 0.791-0.868) and PELOD-2 (0.816; 0.777-0.854) than for qSOFA (0.739; 0.695-0.784) and SIRS (0.710; 0.664-0.756). CONCLUSIONS:SIRS criteria lack specificity to identify children with infection at substantially higher risk of mortality. We demonstrate that adapting Sepsis-3 to age-specific criteria performs better than Sepsis-2-based criteria. Our findings support the translation of Sepsis-3 into paediatric-specific sepsis definitions and highlight the importance of robust paediatric organ dysfunction characterization.
Keywords: Childhood; critical care; mortality; infection; PELOD; sepsis; SIRS; SOFA; scores
Rights: © The Author(s) 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
RMID: 0030115135
DOI: 10.1007/s00134-017-5021-8
Grant ID: http://purl.org/au-research/grants/nhmrc/606978
Appears in Collections:Public Health publications

Files in This Item:
File Description SizeFormat 
hd_119430.pdfPublished Version670.08 kBAdobe PDFView/Open


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.