Association Between Early Bedside Clinical Findings and Need for Organ Support or Mortality in Critically Ill Children: A Multicenter Study.

OBJECTIVES

To identify early bedside clinical predictors of the need for organ support and mortality among critically ill children presenting to pediatric emergency departments (EDs).

METHODS

We conducted a prospective, registry-based, multicenter observational study across 21 pediatric emergency departments endorsed by the Spanish Society of Pediatric Emergencies. Critically ill children evaluated on the 4th, 14th, and 24th days of each month between February 2021 and July 2024 were included. Critical illness was defined as pediatric intensive care unit admission or advanced airway or circulatory intervention in the ED. The Pediatric Assessment Triangle (PAT) was recorded at arrival. Multivariable logistic regression was used to identify factors associated with severe clinical outcomes and mortality. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC).

RESULTS

We included 412 critically ill children; 63 (15.3%) had severe clinical outcomes, and 12 (2.9%) died. Abnormal circulation and appearance when evaluating the PAT and abnormal systolic blood pressure were independently associated with severe clinical outcomes (AUC: 0.75; 95% CI: 0.68-0.82). Prior pediatric intensive care unit admission and abnormal appearance and abnormal circulation when evaluating the PAT were independently associated with mortality (AUC: 0.85; 95% CI: 0.76-0.95).

CONCLUSIONS

Structured bedside assessment at ED presentation may provide clinically meaningful prognostic insight, supporting earlier prioritization and escalation of care for critically ill children, pending external validation.