pSOFA Score

Aka: pSOFA Score, Pediatric Sequential Organ Failure Score

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II. Indications

  1. Sepsis diagnosis and severity evaluation in children

III. Precautions

  1. pSOFA Score should not be used to drive or assess specific Sepsis management

IV. Criteria (based on worst available values in last 24 hours)

  1. Respiratory Function (using SpO2/FIO2 from Pulse Oximetry, or PaO2/FIO2 from ABG)
    1. Score 0: SpO2/FIO2 >=292 (or PaO2/FIO2 >400)
    2. Score 1: SpO2/FIO2 <292 (or PaO2/FIO2 <400)
    3. Score 2: SpO2/FIO2 <264 (or PaO2/FIO2 <300)
    4. Score 3: SpO2/FIO2 <220 (or PaO2/FIO2 <200) with respiratory support
    5. Score 4: SpO2/FIO2 <148 (or PaO2/FIO2 <100) with respiratory support
  2. Cardiovascular Function (using mean arterial pressure and Vasopressors)
    1. Score 0: Mean Arterial Pressure (MAP) above age related threshold
      1. Age <1 month >46 mmHg
      2. Age <11 months >55 mmHg
      3. Age <23 months >60 mmHg
      4. Age <59 months >62 mmHg
      5. Age <143 months >65 mmHg
      6. Age <216 months >67 mmHg
      7. Age >216 months (or adult) >70 mmHg
    2. Score 1: Mean Arterial Pressure (MAP) less than age related cutoff for Score 0
    3. Score 2: Dopamine <=5, OR any Dobutamine
    4. Score 3: Dopamine >5 OR Norepinephrine <=0.1 OR Norepinephrine bitartrate <=0.1
    5. Score 4: Dopamine >15 OR Norepinephrine >0.1 OR Epinephrine >0.1 OR Norepinephrine bitartrate >0.1
  3. Hepatic Function (using serum Total Bilirubin)
    1. Score 0: Serum Bilirubin <1.2 mg/dl
    2. Score 1: Serum Bilirubin 1.2 to 1.9 mg/dl
    3. Score 2: Serum Bilirubin 2.0 to 5.9 mg/dl
    4. Score 3: Serum Bilirubin 6.0 to 11.9 mg/dl
    5. Score 4: Serum Bilirubin >12 mg/dl
  4. Renal Function (using Serum Creatinine)
    1. Score 0: Serum Creatinine below age related threshold
      1. Age <1 month <0.8 mg/dl
      2. Age <11 months <0.3 mg/dl
      3. Age <23 months <0.4 mg/dl
      4. Age <59 months <0.6 mg/dl
      5. Age <143 months <0.7 mg/dl
      6. Age <216 months <1.0 mg/dl
      7. Age >216 months (or adult) <1.2 mg/dl
    2. Score 1: Serum Creatinine above age related threshold
      1. Age <1 month >0.8 mg/dl
      2. Age <11 months >0.3 mg/dl
      3. Age <23 months >0.4mg/dl
      4. Age <59 months >0.6 mg/dl
      5. Age <143 months >0.7 mg/dl
      6. Age <216 months >1.0 mg/dl
      7. Age >216 months (or adult) >1.2 mg/dl
    3. Score 2: Serum Creatinine above age related threshold
      1. Age <1 month >1.0 mg/dl
      2. Age <11 months >0.5 mg/dl
      3. Age <23 months >0.6 mg/dl
      4. Age <59 months >0.9 mg/dl
      5. Age <143 months >1.1 mg/dl
      6. Age <216 months >1.7 mg/dl
      7. Age >216 months (or adult) >2.0 mg/dl
    4. Score 3: Serum Creatinine above age related threshold
      1. Age <1 month >1.2 mg/dl
      2. Age <11 months >0.8 mg/dl
      3. Age <23 months >1.1 mg/dl
      4. Age <59 months >1.6 mg/dl
      5. Age <143 months >1.8 mg/dl
      6. Age <216 months >2.9 mg/dl
      7. Age >216 months (or adult) >3.5 mg/dl
    5. Score 4: Serum Creatinine above age related threshold
      1. Age <1 month >1.6 mg/dl
      2. Age <11 months >1.2 mg/dl
      3. Age <23 months >1.5 mg/dl
      4. Age <59 months >2.3 mg/dl
      5. Age <143 months >2.6 mg/dl
      6. Age <216 months >4.2 mg/dl
      7. Age >216 months (or adult) >5.0 mg/dl
  5. Coagulation Function (using Platelet Count)
    1. Score 0: Platelet Count >= 150 x10^3/mm3
    2. Score 1: Platelet Count < 150 x10^3/mm3
    3. Score 2: Platelet Count < 100 x10^3/mm3
    4. Score 3: Platelet Count < 50 x10^3/mm3
    5. Score 4: Platelet Count < 20 x10^3/mm3
  6. Neurologic Function (using Glasgow Coma Scale)
    1. Score 0: Glasgow Coma Scale (GCS) 15
    2. Score 1: Glasgow Coma Scale (GCS) 13 to 14
    3. Score 2: Glasgow Coma Scale (GCS) 10 to 12
    4. Score 3: Glasgow Coma Scale (GCS) 6 to 9
    5. Score 4: Glasgow Coma Scale (GCS) <6

V. Interpretation: Total SOFA Score 0 to 24

  1. Sepsis criteria (in addition to current infection)
    1. pSOFA Score >=2 (or change in SOFA Score by 2 or more points)

VI. Resources

  1. pSOFA Score Criteria
    1. https://medicalcriteria.com/web/psofa/

VII. References

  1. Matics (2017) JAMA Pediatr 171(10):e172352 [PubMed]

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