A REPORT OF THE USE OF THE DYNAMIC OBJECTIVE RISK ASSESSMENT (DORA) SCORE IN THE CHANGING PEDIATRIC INTENSIVE-CARE ENVIRONMENT

Objective: To assess the clinical use of the Dynamic Objective Risk As sessment (DORA) severity of illness score in a site remote from its de velopment. Design: Prospective chart review. Setting: Tertiary referra l pediatric intensive care unit (PICU). Patients: One hundred sixty co nsecutive admissions involving 621 patient days.Interventions: None. M easurements and Main Results: Pediatric Risk of Mortality (PRISM) scor es were collected daily for all PICU patient days. Collection of data was performed by a physician not directly involved in the ordering of vital signs or laboratory data. The daily DORA score was calculated fr om the previous day's PRISM score and the admission PRISM score accord ing to a previously described formula. The DORA score determines the p atient's risk of mortality for the next 24 hrs. Also documented were t he tests not ordered for each patient day, The sensitivity and specifi city of the DORA score in our patient population were very similar to that previously reported using the previously described 1% cutoff for predicted mortality. We also noted that the tests ordered were related to the physician's perception of the patient's degree of sickness, an d were themselves predictive of outcome. Conclusion: An outcome scorin g system created in one group of PICUs can be applied to patients in a nother PICU remote from where the scoring system was developed with si milar ability to predict outcome.