Validation of utilizing the pediatric Sequential Organ Failure Assessment scoring system in patients with congenital heart disease
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The Sequential Organ Failure Assessment has been used to track a patient’s status for over two decades. It essentially provides a numeric value to quantify the severity of organ dysfunction, most commonly used in sepsis (1). This assessment system was primarily developed for adult patients. However, this threshold cannot be applied in pediatric patients as organ function matures over time. A team of researchers published a paper in 2017 describing the SOFA scale adjusted for pediatric populations (Pediatric Sequential Organ Failure Assessment; pSOFA). Furthermore, they conducted a retrospective study to validate the use of their pSOFA scoring system in pediatric patients admitted to the general Intensive Care Unit. This demonstrated a good correlation with the study for adult patients (2). Patients with congenital heart disease (CHD) often have abnormal circulatory patterns, which can significantly affect cardiovascular and respiratory systems at baseline. This thesis project aims to explore the utilization of pSOFA in assessing the severity of illness in critically ill pediatric patients with congenital heart disease (CHD). Retrospective data collection was carried out in a population of patients with CHD during their stay in the Cardiac ICU (CICU) at Boston Children’s Hospital. Two pSOFA scores, separated based on using indirect vs. direct bilirubin values, were assigned each day spent in the CICU for 101 patients. Of these 101 patients, 50 had a diagnosis of cyanotic CHD while 51 patients had acyanotic CHD. pSOFA scores were compared between cyanotic and acyanotic patients with CHD as well as with a cohort of patients without CHD. This was an exploratory study which provides a deeper understanding for future analysis in order to validate the utilization of pSOFA in a population of patients with CHD.