PROSPECTIVE EVALUATION OF CLINICAL SCORING SYSTEMS IN INFANTS AND CHILDREN WITH CARDIOPULMONARY INSUFFICIENCY AFTER CARDIAC-SURGERY

Objective. To document severity of illness and to evaluate the predict ive value of clinical scoring systems in infants and children with car diopulmonary insufficiency after cardiac surgery. Design. Prospective study with follow up to hospital discharge. Setting. A multidisciplina ry pediatric ICU in a University Hospital. Patients. Between 1/1989 an d 4/1992 441 infants and children with congenital heart disease underw ent open heart surgery. 128 of these patients developed postoperative cardiopulmonary insufficiency and were entered into this study. Method s. Data relevant to the Acute Physiologic Score for Children (APSC), P ediatric Risk of Mortality (PRISM), Therapeutic Intervention Scoring S ystem (TISS) and Organ System Failure (OSF) score were collected in al l patients during the first 4 days of postoperative intensive care. Re sults. The mean age of the patients was 1.5+/-0.2 years. The mean dura tion of mechanical ventilation and ICU care was 6.2+/-0.6 and 8.1+/-0. 7 days, respectively. On the first postoperative day the mean APSC and PRISM scores of survivors and nonsurvivors were 13.9+/-1.3 vs 24.5+/- 1.3 (p<0.001) and 6.1+/-0.5 vs 19.6+/-1.3 (p<0.001), respectively. The mean TISS and OSF scores of survivors and nonsurvivors were 46+/-0.8 vs 57.8+/-1.4 (p<0.001), and 2.2+/-0.2 vs 3.4+/-0.2 (p<0.001), respect ively. The overall hospital mortality rate was 9.9%, the hospital mort ality rate of patients with postoperative cardiopulmonary insufficienc y 34%. Patients with an APSC score <10 and a PRISM score <5 had a surv ival rate of 100%, whereas patients with an APSC score >30 and a PRISM score >25 had a mortality rate of 100%. The area under the receiver o perating characteristic (ROC) curve for APSC, PRISM and TISS was 0.847 , 0.826 and 0.793, respectively. Conclusion. APSC, PRISM and TISS desc ribe accurately severity of illness in infants and children with cardi opulmonary insufficiency after cardiac surgery and all scores identify those patients at increased risk for mortality.