title: Prospective evaluation of clinical scoring systems in infants and children with cardiopulmonary insufficiency after cardiac surgery.
abstract: OBJECTIVE
  To document severity of illness and to evaluate the predictive value of clinical scoring systems in infants and children with cardiopulmonary insufficiency after cardiac surgery.
  
  
  METHODS
  Prospective study with follow up to hospital discharge.
  
  
  METHODS
  A multidisciplinary pediatric ICU in a University Hospital.
  
  
  METHODS
  Between 1/1989 and 4/1992 441 infants and children with congenital heart disease underwent open heart surgery. 128 of these patients developed postoperative cardiopulmonary insufficiency and were entered into this study.
  
  
  METHODS
  Data relevant to the Acute Physiologic Score for Children (APSC), Pediatric Risk of Mortality (PRISM), Therapeutic Intervention Scoring System (TISS) and Organ System Failure (OSF) score were collected in all patients during the first 4 days of postoperative intensive care.
  
  
  RESULTS
  The mean age of the patients was 1.5 +/- 0.2 years. The mean duration 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 +/- 1.9 (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), respectively. The overall hospital mortality rate was 9.9%, the hospital mortality rate of patients with postoperative cardiopulmonary insufficiency 34%. Patients with an APSC score < 10 and a PRISM score < 5 had a survival 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 operating characteristic (ROC) curve for APSC, PRISM and TISS was 0.847, 0.826 and 0.793, respectively.
  
  
  CONCLUSIONS
  APSC, PRISM and TISS describe accurately severity of illness in infants and children with cardiopulmonary insufficiency after cardiac surgery and all scores identify those patients at increased risk for mortality.
authors.affiliation: Department of Pediatrics, University of Graz, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Zobel
authors.forename: S
authors.initials: S
authors.lastname: Rödl
authors.forename: B
authors.initials: B
authors.lastname: Rigler
authors.forename: H
authors.initials: H
authors.lastname: Metzler
authors.forename: D
authors.initials: D
authors.lastname: Dacar
authors.forename: H M
authors.initials: HM
authors.lastname: Grubbauer
authors.forename: A
authors.initials: A
authors.lastname: Beitzke
mesh_terms: D002303:Cardiac Output, Low / Q000145:classification; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011183:Postoperative Complications / Q000145:classification*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012131:Respiratory Insufficiency / Q000145:classification*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index