الفهرس 
Chapter 1: Pediatric Intensive Care Unit (PICU)Only 14 pages are availabe for public view
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Abstract
Estimation of disease morbidity and mortality are important elements in determining the prognosis of patients in pediatric intensive care unit (PICU).
In PICU, mortality correlates with the number of organ dysfunction and failure within any given organ system. Many scores such as Sequential related Organ Failure Assessment (SOFA) score have been developed to assess the degree of organ dysfunction quantitatively in attempt to predict morbidity in critically ill children admitted in the PICU.
The SOFA score is a relatively simple scoring system that can be routinely applied in PICU.
The aim of the present study was to assess the value of a pediatric version of SOFA score for prediction of prognosis among the general PICU population as well as to evaluate SOFA utility for sepsis diagnosis
The study included 281 pediatric patients from the age of 1 month to 18 years who were admitted to the PICU of two hospitals in Egypt: Menoufia University Hospital and Atfal Misr Hospital.
All patients were subjected to the following:
1. Full history of the patients, including personal, present, past, developmental, vaccination, and nutritional history.
2. Through clinical examination:
• Anthropometric measurements.
• General and local system examination (chest, heart, abdomen, CNS, muscloskeletal, urological, and hematological).
3. Clinical Scoring systems including:
• Pediatric SOFA score was calculated to all patients in the first 24 hours of admission In addition to SOFA, we calculated PRISM and
PIM-2 scores.
• The number of SIRS criteria in each patient was determined on admission.
4. Investigations: complete blood count (CBC), C-reactive protein (CRP), blood gas analysis, blood glucose, serum electrolytes, and coagulation profile in addition to liver and kidney function tests. Cultures of body fluids, including blood, urine, cerebrospinal fluid (CSF), and pleural fluid were performed as clinically indicated to search for infections.
All patients were followed up till hospital discharge and the primary outcome was the 30-day mortality rate.
Results of our study showed:
In the present study, 281 critically ill children were recruited. Among them 150 were suspected to have infection which were confirmed by culture in only 34% of them. Among patients with infections, 96 had SIRS and were classified as “sepsis”.
The most frequent reason for PICU admission was respiratory disorders, particularly pneumonia.
SOFA score was significantly higher among non-survivors compared with survivors.
ROC curve analysis showed that SOFA score is the best predictor of mortality among the general PICU population with an AUC of 0.886, a sensitivity of 80.9%, and a specificity of 81.8%.
SOFA score was superior to both PRISM and PIM2 for mortality prediction among the general PICU population and among patients with infections.
SOFA score is well calibrated.
SOFA score showed significant moderate positive correlations with PRISM and PIM2.
SOFA also showed significant weak positive correlation with the length of PICU stay.
Among the patients with proven or suspected infection, the AUC for prediction of mortality by SOFA was higher than that of SIRS. The SOFA cutoff for diagnosis of pediatric sepsis appears to be 3 or more points.