(791) Pediatric SOFA Scores Are Associated With Code Events in Critically Ill Children

Introduction: Critically ill children are at risk of clinical deterioration, including code events such as respiratory failure and cardiopulmonary arrest. At the bedside, most instances of clinical deterioration are detected as they occur, as opposed to predicted in advance, leaving little opportunity for early intervention. The pediatric Sequential Organ Failure Assessment (pSOFA) score is a validated scoring tool of organ dysfunction with excellent discrimination for in-hospital mortality in critically ill children. Our electronic health record (EHR) displays real-time pSOFA scores to augment situational awareness of patients with the highest organ dysfunction burden. Our aim was to determine how well pSOFA discriminates the occurrence of code events in this population.

Methods: We performed a retrospective chart review of all code alarms in the PICU between 5/2020 and 4/2023. Demographic and clinical variables were extracted from the EHR. pSOFA scores recorded from PICU admission to discharge included the maximum total score, organ-specific scores, and change in score over 6-hour intervals. The primary outcomes were receipt of compressions, code-dose epinephrine, or intubation/re-intubation in the subsequent 6-hour interval. Statistical analyses included univariate and multivariable logistic regression and performance using the area under the receiver operating characteristic curve.

Results: Eight hundred and eight code alarms were reviewed, of which 32% of alarms were considered true events. One hundred events included compressions, 83 included code-dose epinephrine, and 56 included intubation. The total pSOFA score was significantly associated with receipt of compressions (OR 1.16, 95% CI 1.11-1.22), code-dose epinephrine (OR 1.24, 95% CI 1.18-1.30), and intubation (OR 1.07, 95% CI 0.98-1.15). Several organ-specific scores were also significantly associated with the three outcomes. AUROC for total score performance was 0.63 for compressions, 0.74 for epinephrine, and 0.58 for intubation.

Conclusions: The pSOFA score has good discrimination of code events in critically ill children and may be used to augment situational awareness of an at-risk population. Prediction of these events may be improved with more granular data.