Validation of Pediatric Sequential Organ Failure Assessment (pSOFA) Scores to Predict Critical Events in the Pediatric Intensive Care Unit

Objective To determine the prognostic value of the Pediatric Sequential Organ Failure Assessment (pSOFA) to discriminate critical events, including code events and intubations, in the pediatric intensive care unit (PICU).Methods We performed an observational cohort study of all critical events in a quaternary care PICU between 5/2020 and 4/2023. Critical events were extracted from our hospital communications platform and from the electronic health record (EHR). The pediatric sequential organ failure assessment (pSOFA) scores were prospectively calculated in real-time in our EHR every 15 min during the study period for data-driven situational awareness and were retrospectively analyzed for this study. Each encounter was divided into 6-h time blocks and we assessed the performance of the highest pSOFA score in each block at discriminating the occurrence of a critical event in the subsequent block.Results There were 5687 unique patient encounters included in the analysis. Critical events were identified in 578 out of 169 486 time blocks (prevalence 0.3%), which included 103 code events and 498 intubation events, in 392 unique PICU encounters. The total pSOFA score in a 6-h time block was significantly associated with a subsequent code event (odds ratio [OR] 1.19, 95% CI 1.13-1.24) or intubation (OR 1.13, 95% CI 1.10-1.15). Several organ-specific pSOFA subscores were also significantly associated with the outcomes. Area under the receiver operating characteristic curve (AUROC) for the total pSOFA score was 0.67 for a code event and 0.65 for intubation. Using a pSOFA score cutoff of >= 8, the positive predictive value was 0.8% and the negative predictive value was 99.7% for any critical event.Conclusions The pSOFA score is significantly associated with critical events in the PICU, however, it does not have adequate performance to be used for situational awareness by itself.