Objective To document severity of illness and to evaluate the predictive value of clinical scoring systems in children after cardiac surgery.
Methods A 12-bed multidisciplinary paediatric intensive care unit (PICU); from 1990 to 2006 1463 infants and children were admitted after open heart surgery. Data relevant to the acute physiological score for children (APSC), paediatric risk of mortality (PRISM III) and organ system failure (OSF) score were collected for all patients during the first 4 days of postoperative intensive care. 81% of the patient underwent a total repair, 19% had a palliative correction.
Results The mean age of the patients was 4.0 ± 5.5 years. There were 1416 survivors and 49 non-survivors. The mean duration of mechanical ventilation was 4.8 ± 16.8 days for survivors and 8.9 ± 8.8 days for non-survivors. On the first postoperative day the mean APSC, PRISM III and OSF scores of survivors and non-survivors were 7.04 ± 4.9 versus 19.9 ± 9.2 (p<0.0001), 1.61 ± 3.3 versus 11.5 ± 10.7 (p<0.0001) and 1.12 ± 0.89 versus 2.5 ± 1.91 (p<0.0001), respectively. 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%.
Conclusion APSC, and PRISM describe accurately the severity of illness in infants and children after cardiac surgery and all physiological scores identify those patients at increased risk of mortality.