(790) TISS-28 Scores to Predict PICU Outcomes in Children With Complex Chronic Conditions: A Pilot Study

Introduction: Pediatric patients with complex chronic conditions (CCC) has increased. CCC patients are medically fragile, diverse and disproportionately impact the medical system. They have higher resource utilization and worse outcomes compared to the general population. Obtaining large-scale data of their outcomes is challenging due to their heterogeneity. One approach is to utilize outcome prediction scores. There is no validated scoring tool available to assess and predict outcomes for these patients. Therapeutic Intervention Scoring System-28 (TISS-28) is a validated tool that has been used in medically complex adults. The goal of this pilot study is to determine the feasibility and utility of TISS-28 as an outcome predictor tool and its correlation to PICU length of stay (LOS) in CCC pediatric patients as well as compare it to a standard outcome measure, Pediatric Risk of Mortality-3 (PRISM-3).

Methods: A retrospective cohort study was completed in a 24-bed PICU in a quaternary care children’s hospital. Unique patient encounters, < 18 years of age between Jan 1, 2022 and Jan 31, 2022 were included. CCC patients were defined by ICD-9 and ICD-10 codes from the Feudtner classification system and were compared to non-CCC patients. TISS-28 and PRISM-3 scores were calculated for both cohorts at PICU admission. Linear regression models were used where appropriate to estimate the association of TISS-28 with PICU LOS for our two cohorts.

Results: Among 50 patient encounters, 23 (46%) were identified as CCC. PRISM-3 (1.4 vs 0.3, p= < 0.001) and TISS-28 (22.8 vs 14.4, p= < 0.001) were significantly higher in the CCC cohort. CCC patients had significantly longer PICU LOS (days) when compared to their non-CCC counterparts (4.3 vs 1.3, p= < 0.001). Only TISS-28 remained independently associated with longer PICU LOS (p= < 0.001) on multivariate analysis.

Conclusions: TISS-28 may be a useful tool for early identification of CCC patients who are at risk for worse outcomes in the PICU compared to our current standard and allow for timely, mindful interventions. TISS-28 data could lead to improvement in care efforts and a more equitable healthcare system for this population. Larger retrospective and prospective studies are necessary to validate the role of TISS-28 in CCC pediatric patients.