Pediatric sequential organ failure assessment score in a congenital heart defect population
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BACKGROUND: Researchers recently created a new scoring system for characterizing organ dysfunction in critically ill pediatric patients, named the pSFOA (pediatric sequential organ failure assessment). Support for applying this scoring system in pediatric patients who suffer from cyanotic and acyanotic congenital heart diseases has not been evaluated. OBJECTIVES: To compare the pSOFA scores between pediatric patients with acyanotic and cyanotic congenital heart disease (CHD). Exampine the pSOFA results of CHD patients with pediatric patients who underwent hematopoietic stem cell transplantations. METHODS: A retrospective case-study of pediatric patients with congenital heart disease admitted to the CICU at Boston Children’s Hospital in 2018. Patients were included if between 1 and 5 years of age, neonates of less than a month old were excluded. A total of 101 patients were reviewed, 50 with cyanotic CHD and 51 with acyanotic CHD. Patient vital signs were assessed using the pSOFA scoring system, with scores assigned based on indices of respiratory, coagulation, hepatic, cardiovascular, neurologic, and renal system function. Scores were analyzed using two-tailed nonparametric Mann-Whitney tests with an alpha of 0.05. The pSOFA scores of CHD patients were then compared to patients who were admitted to the ICU at Boston Children’s Hospital after they received a hematopoietic stem cell transplantation (HSCT). Dunn’s multiple comparisons tests were performed for the two CHD groups and the HSCT patients. An alpha value of 0.05 was also used for these tests. RESULTS: Parameters determined to be statistically significant between the cyanotic and acyanotic CHD patients were, Total High Direct score, Total Average Direct score, Total Low Indirect Score, Total High Indirect score, Neurologic High score, Average Neurologic score, Renal High score, Average Renal score, and Hepatic Low Indirect score. The parameters that were statistically different between the CHD groups and the HSCT group were Age, Maximum Coagulation, Maximum Renal, Maximum Hepatic, and Maximum Total pSOFA scores. Parameters that were significantly different only between cyanotic CHD and HSCT were Maximum Cardiovascular and Maximum Respiratory. Scores that were significantly different between acyanotic CHD and HSCT were Maximum Neurologic. CONCLUSIONS: There were significant differences in pSOFA scores between children with cyanotic CHD and acyanotic CHD, specifically regarding total direct, total indirect, neurologic, and renal scores. Additional research is required to explain these scores differences and validation of these scores in predicting morbidity and mortality outcomes in these patient populations.