(756) Development and Validation of a PICU Admission Triage Score: A Prospective Observational Study

Introduction: Given the huge burden of critically ill children and relative scarcity of PICU beds in a resource limited set up, a mismatch between demand and supply is inevitable. Such a scenario warrants judicious use of these beds for the right patient at the right time. The objective of this study was to develop and validate a PICU admission triage score that could help intensivists make this decision better

Methods: This was a prospective observational study that enrolled all children between >1 month to 12 years admitted in the emergency department (ED) for whom a PICU bed was requested. The study was conducted in two phases viz development and validation. The PICU admission triage (PiCAT) score was developed from predictors of mortality among those who got a PICU bed (PICU survivors vs. non-survivors), and those who could not (ED survivors vs. non-survivors) using univariate and multivariate analysis and model receiver operating curve (ROC). In the validation phase, children were selected for PICU admission based on (PiCAT) score and their outcome (mortality) was assessed.

Results: A bedside PiCAT score (range 0-8) comprising of six-items viz presence of comorbidity, shock, post-arrest state, neurological and hepatic dysfunction and need for ventilation was developed from data of 300 children. A score of 3 had sensitivity and specificity of 88.5% and 88.4% respectively. The absolute risk of mortality increased from 3.3% at 3 to 50% at score of 6. In the validation cohort, 250 children with scores between > 2 to < 6 were accepted for PICU admission. Applying this score showed a significant reduction in day 28 mortality (9.3% Validation vs. 16.1% in development cohort).

Conclusions: PiCAT score is a simple bedside clinical scoring tool that can assist critical care physicians in resource limited set up for selecting critically ill children who may benefit the most with PICU care.