(1764) Pediatric Sequential Organ Failure Assessment (pSOFA) Scoring in Pediatric Burn Patients

Introduction: The Pediatric Sequential Organ Failure Assessment (pSOFA) score allows providers to determine risk of in-hospital mortality in critically ill children. pSOFA has been studied to have good-to-excellent discrimination of in-hospital mortality [1] and was validated for use in septic and critically ill children [2]. pSOFA needs validation in other subsets of critically ill children, including burn patients. The goal of this research is to determine if pSOFA is a reliable tool to discriminate mortality amongst critically ill pediatric burn patients.

Methods: This is a retrospective cohort study with pediatric burn patients, aged 0-21 years old, admitted to the University of Florida (UF) Shands Pediatric ICU (PICU) between 1/1/2012 to 7/23/2020. Exclusion criteria included patients with minor burns and not admitted to PICU. 120 of 205 patients met inclusion criteria. Each patient was characterized into categories based on the American Burn Association Classification: moderate, major, and severe. Through coding from the UF Center of Technology, the mean pSOFA scores from admission (hour 0) to day 7 (hour 168) were extracted and additional data was manually collected. The primary outcome measured is mean pSOFA scores of each burn category at timepoints within the first week of admission, with secondary outcomes to characterize risk of in-hospital mortality in this patient population.

Results: The mean average pSOFA scores at hour 0, 24, 48, 72, 96, 120, 144, and 168 during admission were collected with 95% confidence interval. The severe burn group (mean pSOFA 3) was found to have the highest pSOFA score at hour 0 amongst the moderate (mean pSOFA 1) and major (mean pSOFA 2) burn groups. pSOFA scores had a similar trend and was not significantly elevated in the moderate and critical groups in the first 24 hours.

Conclusions: Amongst critically ill children who are admitted to the PICU for moderate, major, or severe burns, pSOFA can be trended during the acute phase of resuscitation to determine end-organ dysfunction and can have better discrimination in patients with severe burns. Given the similarities in pSOFA trends between patients with moderate and critical burns, there may need to be reconsideration of fluid resuscitation in these groups during the first 24 hours of hospitalization.