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Comparing Vasoactive-Inotropic Score Reporting Strategies in the PICU Relative to Mortality Risk*

Musick, Matthew A., MD; Loftis, Laura L., MD; Kennedy, Curtis E., MD

doi: 10.1097/PCC.0000000000001738
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Objectives: High Vasoactive-Inotropic Scores have demonstrated association with poor outcomes in pediatric cardiac ICUs and are being calculated more frequently in studies of critically ill noncardiac patients. Available studies differ in their approach to assigning Vasoactive-Inotropic Scores, making direct comparisons difficult. The goal of this investigation is to compare multiple approaches to Vasoactive-Inotropic Score assignment to determine their strength of association with mortality in a general pediatric intensive care population. In doing so, we aim to help validate the use of the Vasoactive-Inotropic Score in noncardiac patients and to help inform future studies of the relative strength of available approaches in assigning this score.

Design: Retrospective chart review.

Setting: PICU at an academic freestanding children’s hospital.

Patients: Two-thousand seven-hundred fifty-two consecutive patients admitted over a 17-month time period were screened for receiving inotrope or vasopressor therapies regardless of disease process. Four-hundred seventy-four patients met inclusion criteria.

Interventions: None.

Measurements and Main Results: For each patient treated with continuous infusions of vasoactive medications, a Vasoactive-Inotropic Score was calculated (and then recalculated) every time they had a documented dose change. Multiple strategies were evaluated to generate receiver operating characteristic curves in relation to mortality. Area under the curve was greatest when evaluating the maximum Vasoactive-Inotropic Score (Max Any) during the initial treatment course (0.788) with an increasing relative risk as the score increased. The Vasoactive-Inotropic Score at 48 hours after treatment initiation had next highest area under the curve (0.736). Primary diagnosis categories were also analyzed, and area under the curve was greatest for the cardiovascular group (0.879).

Conclusions: Increasing Vasoactive-Inotropic Scores for patients in the PICU are associated with mortality risk. The scoring strategy used can influence the strength of the association, as can the primary diagnosis category.

All authors: Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.

*See also p. 1172.

This work was performed at Texas Children’s Hospital.

IRB: The institutional review board of Baylor College of Medicine approved the study and waived requirement for informed consent.

Drs. Musick, Loftis, and Kennedy contributed equally to the design of this study and editing of the article. Dr. Musick wrote the article. Dr. Kennedy created the automated data collection program and performed the statistical analysis.

Dr. Musick’s institution received funding from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: mamusick@texaschildrens.org

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies