COMPARISON OF TOPRSS SCORE & PEDIATRIC EARLY WARNING SCORE (PEWS) IN PREDICTING OUTCOME IN PEDIATRIC INTENSIVE CARE UNIT

Abstract

Objective

To determine the predictive performance of the TOPRSS score and the Paediatric Early Warning Score (PEWS) in predicting mortality among critically ill children admitted to the PICU.

Methodology

This cross-sectional study was conducted from November 2024 to April 2025 in the Paediatric Intensive Care Unit of The Indus Hospital, Karachi. A consecutive sample of 344 children aged 1 month to 16 years admitted to the PICU/PHDU was enrolled after guardian consent. TOPRSS and PEWS were recorded at admission, and outcomes included mortality. Data was analysed in SPSS 26 using ROC and logistic regression (p < 0.05).

Results

Among 344 children (mean age 5.1±4.6 years; 59% male), mortality was 25.9%. Non-survivors had significantly higher TOPRSS (4.36 vs 2.35) and PEWS scores (7.90 vs 4.59) (both p=0.0001). TOPRSS (AUC 0.943; sensitivity 88.8%; specificity 96.1%) and PEWS (AUC 0.940; sensitivity 79.8%; specificity 98.0%) showed excellent mortality discrimination. Increasing age reduced mortality risk (OR 0.868), while gender showed no significant association.

Conclusion

TOPRSS and PEWS both showed a high accuracy in predicting mortality in critically ill paediatric patients with similar values of AUC and complementary strengths. TOPRSS was more sensitive and PEWS more specific and thus the utility of these two could be useful in risk stratification of patients at the PICU admission stage. Non-survivors showed higher severity scores and more often died, patients with sepsis and comorbidities, such as malignancy, had more frequent mortality. Increasing age was protective. These results indicate that TOPRSS and PEWS can be considered effective early warning systems in paediatric intensive care units still, the findings require multicentre research to establish their generalizability.