Both in affluent and developing nations, there is a significant risk of morbidity and death for critically sick children admitted to the pediatric intensive care unit (PICU) ¹. To objectively measure the severity of the disease and estimate the probability of death at the time of PICU admission , a number of prognostic scores have been created. These scores can be very helpful in treatment planning. Furthermore, since a large portion of the variation in death rates between PICUs is determined by factors other than medical management, such as the primary diagnosis and illness severity at admission, such scores are crucial for evaluating the quality of medical care ^{2, 3}.

Organ malfunction is a stand-in for death in other scores. An excellent candidate marker of disease severity is multiple organ dysfunction syndrome (MODS), which is linked to a significantly higher risk of death. One study found that the mortality rate for MODS was 1% when one organ system was dysfunctional and could rise to 75% when four organ systems were dysfunctional. Mortality is frequently predicted using the Pediatric Risk of Mortality (PRISM), the Pediatric Index of Mortality (PIM), and their revised versions ^{4, 5}.

An accurate prognostic score should be simple, affordable, easy to use, and minimally invasive ⁶. Nonetheless, there is presently no such ideal pediatric mortality prediction score, thus researchers are still working to increase the accuracy of the ratings that are now available and create new ones. The pediatric organ dysfunction scores include the Pediatric Logistic Organ Dysfunction Score(PELOD) ⁷, PELOD-2, and Pediatric Multiple Organ Dysfunction Score (P-MODS) ^{8, 9}. The Sequential Organ Failure Assessment (SOFA) score, formerly known as the Sepsis-Related Organ Failure Assessment, is the score most frequently used to measure organ dysfunction in critically ill adults ¹⁰.

According to the third International Consensus Definitions for Sepsis and Septic Shock [Sepsis-3]: sepsis diagnosis in adults is now thought to be closely related to the SOFA score ¹¹. Researchers are now keen to modify the SOFA for the pediatric population as a result of this. A pediatric variant of the SOFA score (pSOFA) was created recently and was verified in severely unwell children in the past ¹². The pediatric population, on the other hand, has little data available, and the pSOFA score has not yet been verified in low-income nations or through prospective cohort studies. This study's motive was to evaluate the prognostic value of pSOFA score in a diverse cohort of critically ill children in a nation with inadequate resources and ascertain whether the score can forecast the outcome.

The study was conducted after obtaining clearance from the Institutional Ethics Committee (Human), IEC number AMC/EC/PG/5465, dated 21/2/2023.This was a hospital based prospective study, conducted at the Pediatric Intensive Care Unit (PICU) in Assam Medical College and Hospital, Dibrugarh, India. This is a tertiary care referral government hospital. The study was conducted from 1^st July 2023 to 31^st December 2023. All patients from the age group of one month to twelve years, admitted in the PICU were included. Patients with underlying congenital deformities who required surgical correction, patients who were hospitalized for routine treatment before planned procedures such as intravenous immunoglobulin (IVIG), hemodialysis, Children who died within 24 hours of admission and those where parents refused consent, were excluded.

In our study, the most common age group was less than one year of age [Survivors -22(67%), Non-survivors-6(86%)]. The mean age of the study participants was 20.30±30.44 months in the Survivors group and 15.86±24.95 in Non survivors’ group. Male preponderance was observed in our study [Survivors-21(64%), Non-survivors-5(71%)]. The male female ratio was found to be 1.75:1 in Survivors and 2.5:1 in Non-Survivors. Children from the Lower Middle class were predominant in our study [Survivors-28(85%), Non-Survivors-6(86%)].

Cough was the most common presentation in our study [Survivors-25(76%), Non-Survivors-4(57%)] followed by breathing difficulty [Survivors-24(73%), Non-Survivor -4(57%)]. Pulse volume was good in the Survivors [32(97%)] and feeble in Non-Survivors [5(71%)]. Subcostal retraction was positive in both groups [(Survivors- 30(91%), Non-Survivors-4(57%)]. The respiratory rate was found to be more in Survivors and less in Non-survivors and the difference was found to be statistically significant (Table 3).

In survivors, the most common provisional diagnosis was severe pneumonia [24(73%)] followed by meningitis, acute encephalitis syndrome and failure to thrive [2(6%)]. Among the Non- survivors, the commonest provisional diagnosis was Severe pneumonia [3(43%)] followed by meningitis and Acute encephalitis syndrome [2(29%)]. Severe pneumonia [23(73%)] was the most common diagnosis followed by Acute encephalitis syndrome, meningitis, and failure to thrive [2(6%)]. Among the Non-survivors, Meningitis was the most common diagnosis [3(43%)] followed by Septicemia [2(29%)].

33(82.50%) of the study participants were discharged and 7(17.5%) of the study participants died. The mean score was found to be more in those study participants who died, compared to the survivors. There was a difference between the two groups, and it was found to be statistically significant.

The most common presentation in the PICU is the sepsis which is the major cause of mortality and morbidity among the children. It is important for the clinician to predict the patient’s risk accurately within days following the admission 13. To determine a patient’s prognosis and to improve the decision-making process for the patient’s good outcome, scoring systems are used by the health care managers. The scoring system is also useful to predict the outcome and helps inprompt intervention. But developing an optimal scoring system is a challenging task. The pSOFA score helps in discriminating excellently for the PICU population for the in- hospital mortality. The overall mortality rate of our study was 17.5%. This was similar to the results of Lalitha AV et al study where the overall mortality rate was 17.5%. This was lesser than the mortality rate in other developing countries which reported at about 20% in many studies. In our study the most common age group was less than one year of age. The mean age of the study participants was 20.30±30.44 months in Survivors group and 15.86±24.95 in Non survivors group. Male preponderances were observed in our study [Survivors (64%), Non-Survivors (71%)]. Similar results were also seen in the Lalitha Av et al study where male preponderance was observed as 56.8 % in Survivors and 64.3% among Non-Survivors. The male female ratio was found to be 1.75:1 in Survivors and 2.5:1 in Non-Survivors. In El Mashad et al study, the male female ratio of the survivors was found to be 0.9:1 where female preponderance was observed. In non-survivors the ratio was 1.54:1 where male preponderance was seen ¹³. Children from the Lower Middle class were predominant in our study [Survivor-28(85%), Non-Survivors - 6(86%)]. The mean score was found to be more in participants who died (10.86±1.35) compared to those discharged (3.79±2.64). There was a difference between the group and it was found to be statistically significant. Similar results were also seen by Priya Gogia et al, where the mean pSOFA score was found to be more in non-survivors compared to survivors which was statistically significant. Study done by Priya Gogia et al, stated that the pSOFA score done at 72 hours was highly statistically significant. In study done by Ferreira et al, the mean score was taken at initial, after 48 hours and delta sofa score was found to be high in non-survivors compared to survivors and was statistically significant. Early serial evaluation of the score during the first three days of the PICU admission is considered as better indicator for the prognosis than the initial assessment done at admission. Craig DG et al observed that the median SOFA score was found to be higher in patients who died. Thus, pSOFA score can be used as a prognostic indicator in ill children as it is easily available and can be measured routinely compared to other scores.

The pSOFA score at the time of admission is useful for predicting the mortality and outcome the patients in the PICU population. Since the parameters of pSOFA score are less, it offers the advantage of being a relatively simple, cost effective and easy to calculate scoring system. This score focuses on organ dysfunction and provides a comprehensive assessment of the patient’s condition and may facilitate early intervention to prevent further deterioration.