Scoring system to assess disease severity in children

Abstract

A scoring system to assess disease severity in children, based on therapeutic and diagnostic interventions, is suggested. The charts of 475 consecutive admissions to a multidisciplinary pediatric intensive care unit (PICU) were reviewed and therapeutic and diagnostic interventions (TDI) associated with more than 20% mortality identified. These were scored: TDI associated with 20–30% mortality-1 point; 31–40%-2 points; 41–50%-3 points and more than 51%-4 points. According to these values, a Pediatric Therapeutic and Diagnostic Intervention Score (PTDIS) was calculated for each patient. The study population may be divided, according to PTDIS and mortality, into three groups: moderately severe disease associated with up to 2.7% mortality and PTDIS less than 20; severe disease associated with up to 25% mortality and PTDIS less than 35; critically ill patients with more than 50% mortality and PTDIS greater than 36. PTDIS in survivors was 15.2±0.6 (mean±SE) and 43.6±1.1 in non-survivors. Pearson's correlation between PTDIS and mortality was R=0.7162 at a significance level of p<0.0001. PTDIS and mortality were not found to be significantly correlated with sex, age or duration of hospitalization in the Unit. Sepsis, central nervous system infections and burns were the primary diseases, and shock, coma and patients after cardiopulmonary resuscitation the indications for admission to the Unit, associated with the highest mortality and PTDIS. This study demonstrates the efficacy of the suggested PTDIS system in accurately assessing severity of disease in a PICU patient population.