PDF(Pubmed)
Abstract：
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.
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.
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.
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.
Test characteristics of pSOFA scores of 2 or more during the ED stay for hospital mortality.
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).
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.
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.
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.
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.
Test characteristics of pSOFA scores of 2 or more during the ED stay for hospital mortality.
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).
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.
摘要：
小儿败血症的定义已经演变，一些人提出使用成人使用的方法来量化器官功能障碍，在疑似感染的情况下，序贯器官衰竭评估（SOFA）得分为2分或更多。SOFA（pSOFA）的儿科适应在重症儿童中表现出对死亡率的出色歧视，但尚未在急诊科（ED）人群中进行评估。
描述pSOFA评分的测试特征，用于预测（1）所有患者和（2）儿科ED治疗的疑似感染患者的院内死亡率。
这项回顾性队列研究于2012年1月1日至2020年1月31日在美国儿科急诊护理应用研究网络（PECARN）注册的9家儿童医院进行。数据从2020年2月1日至2022年4月18日进行了分析。包括所有小于18岁的患者的ED访问。
EDpSOFA评分是通过对ED住院期间的最大pSOFA器官功能障碍成分进行求和（每个0-4分）。在疑似感染的子集中，确定了脓毒症(pSOFA评分≥2分的疑似感染)和脓毒性休克(血管活性物质输注和血清乳酸水平>18.0mg/dL的疑似感染)的访视会议标准.
住院期间pSOFA评分为2或更高的住院死亡率的测试特征。
共3999528（女，47.3%)包括ED访视。pSOFA评分范围为0至16，其中126250次（3.2%）的pSOFA评分为2或更高。pSOFA评分≥2分的敏感性为0.65（95%CI，0.62-0.67），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）。在642868例疑似感染患者中（16.1%），42992（6.7%）符合脓毒症标准，374例(0.1%)符合感染性休克标准.疑似感染的医院死亡率(599502)，败血症（42992），感染性休克（374）为0.0％，0.9%，和8.0%，分别。在所有ED访视中，pSOFA评分对医院死亡率有相似的区分（接受者工作特征曲线下面积，0.81;95％CI，0.79-0.82）和可疑感染的子集（接受者工作特征曲线下面积，0.82；95%CI，0.80-0.84）。
在一个大的，儿科ED就诊的多中心研究，pSOFA评分≥2分并不常见,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或更低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定义的脓毒性休克患者的死亡率最高.
描述pSOFA评分的测试特征，用于预测（1）所有患者和（2）儿科ED治疗的疑似感染患者的院内死亡率。
这项回顾性队列研究于2012年1月1日至2020年1月31日在美国儿科急诊护理应用研究网络（PECARN）注册的9家儿童医院进行。数据从2020年2月1日至2022年4月18日进行了分析。包括所有小于18岁的患者的ED访问。
EDpSOFA评分是通过对ED住院期间的最大pSOFA器官功能障碍成分进行求和（每个0-4分）。在疑似感染的子集中，确定了脓毒症(pSOFA评分≥2分的疑似感染)和脓毒性休克(血管活性物质输注和血清乳酸水平>18.0mg/dL的疑似感染)的访视会议标准.
住院期间pSOFA评分为2或更高的住院死亡率的测试特征。
共3999528（女，47.3%)包括ED访视。pSOFA评分范围为0至16，其中126250次（3.2%）的pSOFA评分为2或更高。pSOFA评分≥2分的敏感性为0.65（95%CI，0.62-0.67），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）。在642868例疑似感染患者中（16.1%），42992（6.7%）符合脓毒症标准，374例(0.1%)符合感染性休克标准.疑似感染的医院死亡率(599502)，败血症（42992），感染性休克（374）为0.0％，0.9%，和8.0%，分别。在所有ED访视中，pSOFA评分对医院死亡率有相似的区分（接受者工作特征曲线下面积，0.81;95％CI，0.79-0.82）和可疑感染的子集（接受者工作特征曲线下面积，0.82；95%CI，0.80-0.84）。
在一个大的，儿科ED就诊的多中心研究，pSOFA评分≥2分并不常见,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或更低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定义的脓毒性休克患者的死亡率最高.
