PEDIATRIC SEQUENTIAL ORGAN FAILURE ASSESSMENT SCORE

Pediatric Sequential Organ Failure Assessment Score

Scorea Abbreviations: FiO2, fraction of

inspired oxygen; MAP, mean arterial
Variables 0 1 2 3 4
pressure; pSOFA, pediatric
Respiratory Sequential Organ Failure Assessment;
PaO2:FiO2b ≥400 300-399 200-299 100-199 With <100 With SpO2, peripheral oxygen saturation.
or respiratory support respiratory support SI conversion factors: To
SpO2:FiO2c ≥292 264-291 221-264 148-220 With <148 With
convert bilirubin to micromoles
respiratory support respiratory support
per liter, multiply by 17.104;
Coagulation
creatinine to micromoles per
Platelet count, ≥150 100-149 50-99 20-49 <20
liter, multiply by
×103/μL
88.4; and platelet count to ×109/L,
Hepatic multiply by 1.
Bilirubin, mg/dL <1.2 1.2-1.9 2.0-5.9 6.0-11.9 >12.0 a
The pSOFA score was calculated
Cardiovascular for every 24-hour period. The worst
MAP by age value for every variable in each 24-
group
hour period was used to calculate
or vasoactive
the subscore for each of the 6 organ
infusion, mm Hg
systems. If a variable was not
or μg/kg/mind
recorded in a given 24-hour period,
<1 mo ≥46 <46 Dopamine Dopamine Dopamine
it was assumed to be normal and a
hydrochloride ≤5 hydrochloride >5 or hydrochloride >15 or score of 0 was used. Daily pSOFA
1-11 mo ≥55 <55 score was the sum of the
or dobutamine epinephrine ≤0.1 or epinephrine >0.1 or 6 subscores (range, 0-24 points;
12-23 mo ≥60 <60 hydrochloride norepinephrine norepinephrine higher scores indicate a worse
outcome).
(any) bitartrate ≤0.1 bitartrate >0.1 b PaO2 was measured in
24-59 mo ≥62 <62 millimeters of mercury.
cOnly SpO2 measurements of 97% or
60-143 mo ≥65 <65 lower were used in the calculation.
d MAP (measured in millimeters of
144-216 mo ≥67 <67
mercury) was used for scores 0 and
1; vasoactive infusion (measured in
>216 moe ≥70 <70
micrograms per kiligram per
Neurologic minute), for scores 2 to 4.
Maximum continuous vasoactive
Glasgow Coma 15 13-14 10-12 6-9 <6 infusion was administered for at
Scoref least 1 hour.
e
Renal Cutoffs for patients older than
18 years (216 months) were
Creatinine by age identical to the original SOFA score.
group, mg/dL f Glasgow Coma Scale was
<1 mo <0.8 0.8-0.9 1.0-1.1 1.2-1.5 ≥1.6 calculated using the pediatric scale.

1-11 mo <0.3 0.3-0.4 0.5-0.7 0.8-1.1 ≥1.2

12-23 mo <0.4 0.4-0.5 0.6-1.0 1.1-1.4 ≥1.5

24-59 mo <0.6 0.6-0.8 0.9-1.5 1.6-2.2 ≥2.3

60-143 mo <0.7 0.7-1.0 1.1-1.7 1.8-2.5 ≥2.6

144-216 mo <1.0 1.0-1.6 1.7-2.8 2.9-4.1 ≥4.2

>216 moe <1.2 1.2-1.9 2.0-3.4 3.5-4.9 ≥5

Matics TJ, Pinto LNS. Adaptation and Validation of a Pediatric Sequential Organ Failure Assessment Score
and Evaluation of the Sepsis-3 Definitions in Critically Ill Children. JAMA Pediatrics. 2017; 171 (10): 1-9

PEDIATRIC MULTIPLE ORGAN DYSFUNCTION SYNDROME

Population description
MODS (Proulx)a MODS (Goldstein)b All patientsc

N = 180 N = 314 N = 842

Demographic data
Male 98 (54.5) 168 (53.5) 434 (51.5)
Age (months) 60 ± 72 64 ± 70 72 ± 72
Severity of illness at
PICU entry
PRISM score 11.4 ± 7.8 9.2 ± 7.1 6.0 ± 5.8
Daily PELOD score 10.3 ± 9.4 8.1 ± 8.4 4.8 ± 6.8
Main cause of
admissiond
Respiratory 76 (42.2) 146 (46.8) 298 (36.4)
Disease
Shock
Hypovolemic 10 (5.6) 10 (3.2) 19 (2.5)
shock
Septic shock 17 (9.6) 19 (6.1) 27 (3.2)
Haemorrhagic 4 (2.5) 5 (1.6) 5 (1.6)
shock
Cardiogenic 13 (7.5) 13 (4.2) 15 (1.8)
shock
Congenital heart 29 (16.3) 39 (12.6) 77 (9.2)
disease
Bacterial infection 70 (39.1) 125 (39.9) 237 (28.2)
Viral infection 46 (25.8) 97 (31.1) 203 (24.2)
Trauma
Polytraumatism 4 (2.2) 11 (3.5) 18 (2.4)
Severe head 6 (3.3) 10 (3.1) 11 (1.3)
trauma
Burn 2 (1.1) 2 (0.6) 5 (0.6)
Surgery
Post-cardiac 22 (12.3) 38 (12.1) 105 (12.5)
surgery
Other surgery 17 (9.5) 33 (10.5) 146 (17.4)
(planned)
Other surgery 14 (7.8) 24 (7.7) 63 (7.5)
(unplanned)
Other reasons for 91 (50.6) 145 (46.2) 368 (43.8)
admission
Specific treatment
during PICU stay
ECMO 7 (3.9) 7 (2.3) 7 (0.8)
Haemofiltration 6 (3.3) 7 (2.3) 7 (0.8)
Haemodialysis 10 (5.5) 9 (2.9) 15 (1.5)
At least 1 red cell transfusion 91 (50.6) 101 (32.2) 142 (16.9)

Number (%) or mean ± SD

 ECMO extracorporeal membrane oxygenation, MODS multiple organ dysfunction syndrome, PELOD paediatric logistic organ dysfunction,
PICU paediatric intensive care unit, PRISM paediatric risk of mortality
a
MODS (Proulx): cases of MODS diagnosed during PICU stay, using diagnostic criteria advocated by Proulx in 1996 [4]
b
MODS (Goldstein): cases of MODS diagnosed during PICU stay, using diagnostic criteria advocated by Goldstein in 2005 [5, 6]
c
Include patients with and without MODS
d
There were many causes of admission in some patients

Villeneuve, A., Joyal, J.-S., Proulx, F., Ducruet, T., Poitras, N., & Lacroix, J. (2016). Multiple organ
dysfunction syndrome in critically ill children: clinical value of two lists of diagnostic criteria. Annals of
Intensive Care, 6(1).
 PEDIATRIC LOGISTIC ORGAN DYSFUNCTION SCORE
Table PELOD Scoring System.

Scoring System
Organ Dysfunction
and Variable 0 1 10 20

Neurologicala
Glasgow coma 12-15 and 7-11 4-6 or 3
score
Pupillary reactions Both reactive NA Both fixed NA
Cardiovascularb
Heart rate, bpm
<12 years 195 NA >195 NA
12 years 150 NA >150 NA
and or
Systolic blood pressure, mm Hg
<1 month >65 NA 35-65 <35
1 month-1 year >75 NA 35-75 <35
1-12 years >85 NA 45-85 <45
12 years >95 NA 55-95 <55
Renal
Creatinine, mmol/L
<7 days <140 NA 140 NA
7 days-1 year <55 NA 55 NA
1-12 years <100 NA 100 NA
12 years <140 NA 140 NA
Respiratory
Pao2, kPa/FiO2 >9.3 and NA 9.3 or NA
ratio
Paco2, kPa 11.7 and NA >11.7 NA
Mechanical No ventilation Ventilation NA NA
ventilation
Hematological
White blood cell
9
4.5 and 1.5-4.4 <1.5 NA
count, 10 /L9
Platelets, 10 /L 35 <35 NA NA
Hepatic
Aspartate <950 and 950 or NA NA
transaminase, IU/L
Prothrombin time <60 (<1.40) 60 ( 1.4) NA NA
(or INR)

PaO2: use arterial measurement only. PaO2/FiO2 ration cannot be assessed in patients with intracardiac shunts, is considered as normal in children with cyanotic heart
disease. PaCO2 may be measured from arterial, capillary, or venous samples. Mechanical ventilation: use of mask ventilation is not counted as mechanical ventilation.
a b
Glasgow coma score: use lowest value. If patient sedated, record estimated score before sedation. Pupillary reactions:non-reactive pupils must be > 3mm. Do not
assess heart rate and blood pressure during crying or iatrogenic agitation.
Abrreviations: PaO2, arterial oxygen pressure; FiO2, fraction inspired oxygen; NA, not significant; PaCO2, arterial carbon dioxide pressure; PELOD, Pediatric
Logistic Organ Dysfunction; IU, International Units; INR, international normalized ratio.

Russel RA, Jeffries HE, Ghanayem NS. Relationship Between Risk-Adjustment Tools and the Pediatric
Logistic Organ Dysfunction Score. World Journal for Pediatric and
Congenital Heart Surgery 2014, Vol 5(1) 16–21

PEDIATRIC LOGISTIC ORGAN DYSFUNCTION-2 SCORE

Table 7: Pediatric logistic organ dysfunction score 2
Organ dysfunctions Points by severity levels
and variablesa
0 1 2 3 4 5 6
Neurologicb
Glasgow coma score ≥11 5-10 3-4
Pupillary reaction Both Both
reactive fixed
Cardiovascularc
Lactatemia (mmol/L) <5.0 5.0-10.9 ≥11.0
Mean arterial pressure
(mm Hg) (months)
0-<1 ≥46 31-45 17-30 ≤16
1-11 ≥55 39-54 25-38 ≤24
12-23 ≥60 44-59 31-43 ≤30
24-59 ≥62 46-61 32-44 ≤31
60-143 ≥65 49-64 36-48 ≤35
≥144 ≥67 52-66 38-51 ≤37
Renal
Creatinine (µmoL/L)
(months)
0-<1 ≤69 ≥70
1-11 ≤22 ≥23
12-23 ≤34 ≥35
24-59 ≤50 ≥51
60-143 ≤58 ≥59
≥144 ≤92 ≥93
Respiratoryd
PaO2 (mm Hg)/FiO2 ≥61 ≤60
PaCO2 (mm Hg) ≤58 59-94 ≥95
Invasive ventilation No Yes
Hematologic
WBC count (×109/L) >2 ≤2
Platelets (×109/L) ≥142 77-141 ≤76

aAll variables must be collected, but measurements can be done only if justified by the patient’s clinical status. If a variable is not measured, it should be considered
normal. If a variable is measured more than once in 24 h, the worst value is used in calculating the score;
bNeurologic dysfunction - Glasgow coma score: Use the lowest value. If the patient is sedated, record the estimated Glasgow coma score before sedation. Assess only
patients with known or suspected acute central nervous system disease. Pupillary reactions: Nonreactive pupils must be >3 mm. Do not assess after iatrogenic
pupillary dilatation;
cCardiovascular dysfunction: Heart rate and mean arterial pressure: Do not assess during crying or iatrogenic agitation;
dRespiratory dysfunction: PaO2: Use arterial measurement only. PaO2/FiO2 ratio is considered normal in children with cyanotic heart disease. PaCO 2 can be measured
from arterial, capillary, or venous samples. Invasive ventilation: the use of mask ventilation is not considered invasive ventilation. Logit (mortality)=−6.61+0.47 ×
PELOD-2 score; Probability of death=1/ (1+exp [−logit (mortality)]); FiO 2: Fraction of inspired oxygen; PELOD: Pediatric logistic organ dysfunction; PaO2: Arterial
oxygen pressure; WBC: White blood cell

Gulla KM, Sachdev A. Illness severity and organ dysfunction scoring in Pediatric Intensive Care Unit. Indian
J Crit Care Med 2016;20:27-35.
 PEDIATRIC RISK OF MORTALITY III, PEDIATRIC INDEX OF MORTALITY 3

Table Variables of PRISM III, PIM 2, and PIM 3

PRISM III PIM 2 PIM 3
SBP (mmHg) Absolute (SBP–120) SBP at admission
Heart rate (/min) Pupils fixed to light (Y/N) Pupils fixed to light (Y/N)
Body temperature (°C) FiO2 ×100/PaO2 (mmHg) FiO2 ×100/PaO2 (mmHg)
Pupil reflex Absolute (base excess) Absolute (base excess)
Mental status Mechanical ventilation Mechanical ventilation in the first hour (Y/N)
Total CO2 (mmHg) Elective admission (Y/N) Elective admission (Y/N)
pH Recovery post procedure Recovery post procedure
PaCO2 (mmHg) Bypass (Y/N) From bypass cardiac surgery
Glucose (mg/dl) From non-bypass cardiac surgery
Potassium (mEq/l) From non-cardiac procedure
Creatinine (mg/dl) Risk factora Risk factorb
BUN (mg/dl) Low-risk diagnosis Low-risk diagnosis
White blood cell High-risk diagnosis High-risk diagnosis
Prothrombin time Very high-risk diagnosis
Partial thrombin time
Platelets

PRISM: pediatric risk of mortality; PIM: pediatric index of mortality; SBP: systolic blood pressure; FiO2: fraction of inspired oxygen; PaO2: arterial blood
oxygen partial pressure; BUN: blood urea nitrogen.
a
Low risk: asthma, bronchiolitis, croup, obstructive sleep apnea, diabetic ketoacidosis; high-risk: cardiac arrest, severe combined immune deficiency, leukemia or
lymphoma after fist induction, spontaneous cerebral hemorrhage, cardiomyopathy or myocarditis, hypoplastic left heart syndrome, hu-man immunodeficiency virus
infection, liver failure, neurodegenerative disorder; bLow risk: asthma, bronchiolitis, croup, obstructive sleep apnea, dia-betic ketoacidosis, seizure disorder; high risk:
spontaneous cerebral hemorrhage, cardiomyopathy or myocarditis, hypoplastic left heart syndrome, neu-rodegenerative disorder, necrotizing enterocolitis; very high-
risk: cardiac arrest, severe combined immune deficiency, leukemia or lymphoma after first induction, bone marrow transplant recipient, liver failure. 

Jung JW, Soh IS, Kim MJ, et all. Validation of Pediatric Index of Mortality 3 for Predicting Mortality among
Patients Admitted to a Pediatric Intensive Care Unit. Acute and Critical Care 2018; 33(3): 170-177
 Physiologic Stability Index (PSI)
Physiologic Stability index (PSI) was developed by a group of paediatric intensivists in 1984 from TISS
Table Physiologic stability Index:

Physiologic Systems (7) and Variables (34)

(1) Cardiovascular: systolic blood pressure, diastolic blood pressure, heart rate, cardiac index, C(a-v)O2, CVP, PCWP
(2) Respiratory: respiratory rate, PaO2, PaO2/FIO2, PaCO2
e
Neurologic: Glasgow coma score, intracranial pressure, seizures, pupils
e
Hematologic: hemoglobin, WBC count, platelet count, PT/PTT, FSP
(5) Renal: BUN, creatinine, urine output
(6) Gastrointestinal: AST/ALT, amylase, total bilirubin, albumin
(7) Metabolic: sodium, potassium, calcium, glucose, osmolality, pH, HCO3
Points for each variable:
f 0, 1, 3, 5
f reflect clinical importance of derangement, with more abnormal having higher point value
f not intended to reflect magnitude of deviation from the normal value
Variable 0 points 1 points 3 points 5 points
Systolic blood pressure in mm Hg
• Infants • 66-129 • 55-65, or 130-160 • 40-54, or > 160 • < 40
• Children • 66-149 • 65-75, or 150-200 • 50-74, or > 200 • < 50
Diastolic blood pressure, in mm Hg < 90 90-110 > 110
Heart rate, in beats per minute
• Infants • 91-159 • 75-90, or 160-180 • 50-74, or 181-220 • < 50, or > 220
• Children • 81-149 • 60-80, or 150-170 • 40-59, or 171-200 • < 40 or > 200
Cardiac index, in L per min per square meter > 3.0 2.0-3.0 1.0-1.9 < 1.0
Arterial to mixed venous oxygen 3.0-5.4 < 3.0, or 5.5-6.5 > 6.5
content difference, C(a-v)O2, in ml
O2 per dL (vol%)
CVP, in mm Hg 0-15 < 0, or > 15
Wedge pressure, or left atrial 5-14 < 5, or 15-25 > 25
pressure, in mm Hg
Respiratory rate, in breaths per minute Contd.........

Variable 0 points 1 points 3 points 5 points

• Infants • < 50 • < 30 • 61-90 • > 90, apnea

• Children • 50-60 • 51-70 • 51-70 • > 70
PaO2, in mm Hg > 50 50-60 40-49 < 40
PaO2/FIO2 > 300 200-300 < 200
PaCO2 in mm Hg 30-44 < 30, or 45-50 51-65 < 65
pH 7.31-7.54 7.20-7.30, or 7.55-7.65 7.10-7.19, or > 7.65 < 7.10
Glasgow Coma Score > 11 8-11 5-7 <5
Intracranial pressure, in mm Hg < 15 15-20 21-40 > 40
Seizures focal grand mal or status
epilepticus
Pupils equal and equal and sluggish unequal and sluggish fixed and dilated
responsive
Hemoglobin, in g/dL 7.1-17.9 5.0-7.0, or 18.0-22.0 3.0-5.0, or 22.1-25.0 < 3.0
WBC count, per µL 5,001 - 19,999 3,000-5,000, or < 3,000, or > 40,000
20,000 - 40,000
Platelet count, per µL 51,000 - 999,999 20,000-50,000, or > 1 M < 20,000
PT/PTT ratio, relative to normal <= 1.5 > 1.5
control PT/PTT
Fibrin split products in µg/mL <= 40 > 40
BUN, in mg/dL < 40 40-100 > 100
Creatinine, in mg/dL < 2.0 2.0-10.0 > 10.0
Urine output, in mL per kg per hour > 1.0 0.5-1.0 < 0.5
AST / ALT, in IU/L <= 100 > 100
Amylase, in U/L <= 500 > 500
Total bilirubin, in mg/dL <= 3.5 > 3.5
Serum albumin, in g/dL > 2.0 1.2-2.0 < 1.2
Sodium, in mEq/L 126-149 115-125, or 150-160 < 115, or > 160
Potassium, in mEq/L 3.6-6.4 3.0-3.5, or 6.5-7.5 2.5-2.9, or 7.6-8.0 < 2.5, or > 8.0
Calcium, in mg/dL 8.1-11.9 7.0-8.0, or 12.0-15.0 5.0=6.9, or > 15.0 < 5.0
Glucose, in mg/dL 61-249 40-60, or 250-400 20-39, or > 400 < 20
Osmolality, in mOsm/L < 320 320-350 > 350
Bicarbonate, in mEq/L 16-32 < 16 or > 32
where:
infants are all those under 1 year of age; children are all those older than 1 year of age
AST/ALT is taken to be the ratio of the transaminases
hypoosmolality does not seem be included for evaluation
physiologic stability index =SUM (points for each physiologic variable)
Interpretation
Index scores:
minimum score 0
maximum score 119
higher scores indicate more severe disease
Scores compared:
on day of admission
maximum score
4-day average
trend over hospital course
Trends over hospital course:
decreasing indicates improvement
increasing indicates worsening
unchanging
probability of mortality = (EXP((0.277 * (4 day average PSI)) - 5.241)) / (1 + (EXP((0.277 * ( 4 day average PSI)) - 5.241)))

Bhodaria P and Bhagwat AG. Severity Scoring Systems in Paediatric Intensive Care Units. Indian Journal of
Anaesthesia 2008;52:Suppl (5):663-675