Impact of Optimizing Critical Care Resources in Pediatric Surgery Patients

Abstract

Background: Prediction scores could help to timely identify patients at risk. More intense care monitoring outside the pediatric intensive care unit (PICU) could improve outcomes. These concepts of critical care without borders could be implemented shortly with local resources and improve patient safety. Predict more, do less in PICUs, and more in the ward. The aim of this work was to evaluate the impact of prediction scores for identification of postoperative high risk surgical patients and their need for pediatric intensive care unit admission. Methods: This prospective study was carried out on 40 pediatric patients. The studied patients were divided into three groups. LR Group: 14 cases with ASA = 1, 2 PEWS ≤ 2, pSOFA ≤ 7, LqSOFA < 2. IR Group: 10 cases with PEWS = 3, 4 pSOFA = 8 -11 HiR Group: 16 cases with ASA = 3 -5, PEWS ≥ 5, pSOFA ≥ 12, LqSOFA ≥ 2. American Society of Anaesthesiologists (ASA) scoring was obtained from each patient preop. The Pediatric Early Warning (PEWS) Scoring was obtained from each patient immediately postop. The Pediatric Sequential Organ Failure Assessment (pSOFA) Scoring was obtained from patients admitted to PICU on day 1 and day 7. Liverpool quick Sequential Organ Failure Assessment (LqSOFA) scoring was obtained from all patients on admission. Results: Regarding prognostic performance of different scores to predict mortality.  For ASA score: it was statistically significant with AUC = .882, cut off values > 3, sensitivity = 75%, specificity = 88.89%, PPV = 42.9% and NPV = 97%. -For PEW score: it was statistically significant with AUC = .892, cut off values > 5, sensitivity = 79%, specificity = 80.56%, PPV =30% and NPV = 96.7%.  -For pSOFA score: it was statistically significant with AUC = .931, cut off values > 14, sensitivity = 85%, specificity = 86.11%, PPV =37.5%, and NPV = 96.9%. All ASA, PEW, and pSOFA were statistically significant as univariate but none was significant as multivariate. Conclusions:  ASA score, pSOFA score and PEWS score were significant predictor to length of stay (>21 days). ASA score, PEW score and pSOFA score were significant as predictor to mortality. ASA score and PEWS score were highly significant as to predict PICU Admission postop. PEWS score was highly significant as to predict PICU Admission postop. ASA, PEWs, and pSOFA were predictors for LOS for more than 21 days, predictors of mortality and predictors for PICU admission Postop. Decreased platelets and increased WBCs, urea, creatinine, AST, and RBG were significant with HiR. LqSOFA is a simple variable bedside tool for identifying septic patients at high risk for poor outcomes.