Proposal of a New Pediatric Sequential Organ Failure Assessment Score for Possible Validation

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To the Editor:“Sepsis-3,” a new definition for sepsis and septic shock proposed in early 2016 (1), dramatically impacted on the critical care community around the world to change the concept of sepsis and septic shock from “systemic inflammatory response due to infection” to “acute and potentially lethal organ dysfunctions accompanied with infection.” Recent large-scale, prospective observational study published in a recent issue of Pediatric Critical Care Medicine by Wiens et al (2) has also indicated that the traditional sepsis definition based on systemic inflammatory response syndrome offers little value in identification of children at high risk of mortality. The upcoming new “surviving sepsis campaign guidelines” are expected to be revised for the definition of sepsis in accordance to the aforementioned proposals. Unfortunately, the new wave has not yet reached the pediatric critical care community, but it is obviously undesirable to continue to use the different terms and definition between adults and children.The new Sepsis-3 definition successfully validated a new “Quick Sequential Organ Failure Assessment” score for the early detection of sepsis in the emergency department and Sequential Organ Failure Assessment (SOFA) score for the definition of sepsis in the ICU, using mega but limited-to-adult datasets. However, it remains uncertain whether similar organ failure-oriented scores/definitions should apply to pediatric population. Furthermore, due to the age-based variation in reference ranges of vital signs or other biochemical markers, appropriate SOFA score for the use in pediatrics remains to be established.Although several studies tried to apply SOFA score to children with minor modification (3), those scores had failed to consider neither the age-based variation nor being validated using multiple, larger datasets. We therefore propose a new, simple pediatric SOFA criteria considering the age-based arterial blood pressure (4) and serum creatinine criteria (5), based on previous publication (Tables 1 and 2). Conducting validation studies using a worldwide large datasets would be expected.

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