pSOFA (Pediatric SOFA)

pSOFA total = respiratory + coagulation + hepatic + cardiovascular + neurologic + renal, six organ subscores (each 0–4) summed to 0–24 (Matics & Sanchez-Pinto 2017); the total and all six subscores are reported. Respiratory uses PaO₂:FiO₂ = PaO₂ ÷ FiO₂ when a PaO₂ is present (≥400 → 0, 300–399 → 1, 200–299 → 2, 100–199 → 3, <100 → 4), otherwise SpO₂:FiO₂ = SpO₂ ÷ FiO₂ but only when SpO₂ ≤97% (≥292 → 0, 264–291 → 1, 221–264 → 2, 148–220 → 3, <148 → 4; the published bands print 264 in two rows at once, and an exact 264 is resolved here to the worse subscore 2); subscores 3–4 require respiratory support, and a 3/4-band ratio without support is capped at 2. Coagulation from platelets (×10³/µL): ≥150 → 0, 100–149 → 1, 50–99 → 2, 20–49 → 3, <20 → 4. Hepatic from total bilirubin (mg/dL): <1.2 → 0, 1.2–1.9 → 1, 2.0–5.9 → 2, 6.0–11.9 → 3, ≥12 → 4. Cardiovascular is the worse of the MAP subscore (0 if MAP ≥ the age-band threshold, else 1) and the vasoactive subscore (dobutamine any dose or dopamine ≤5 → 2; dopamine >5 or epinephrine ≤0.1 or norepinephrine ≤0.1 → 3; dopamine >15 or epinephrine >0.1 or norepinephrine >0.1 → 4, doses in µg/kg/min). Neurologic from total GCS: 15 → 0, 13–14 → 1, 10–12 → 2, 6–9 → 3, <6 → 4. Renal from serum creatinine (mg/dL) against age-band cut points ≥ the level-4, -3, -2, or -1 threshold. MAP thresholds and creatinine cut points are age-adjusted across seven age bands (<1, 1–11, 12–23, 24–59, 60–143, 144–216, >216 months); missing oxygenation, MAP, or vasoactive inputs score that organ 0.

Each subscore is the worst qualifying value in the assessment window; the total is their sum (0–24). Missing data is scored as normal (0) for that organ — this is the paper's own rule and not a convention of this platform: the Methods of Matics & Sanchez-Pinto 2017 state that a variable not measured within a 24-hour period was taken as normal, consistent with the original SOFA criteria. It still means a partially entered case reads lower than a fully entered one, so read a low total together with how much was supplied. A PaO₂:FiO₂ or SpO₂:FiO₂ falling in a subscore-3/4 band without respiratory support is capped at 2, the highest band carrying no support requirement. THAT CAP IS THE PUBLISHED TABLE'S OWN STRUCTURE, NOT A RULE THIS CALCULATOR ADDED, and it is no longer flagged as unsourced: subscores 3 and 4 each carry the table's respiratory-support requirement and no lower band carries any support requirement, so a patient who is not on respiratory support cannot satisfy either criterion however low the ratio falls, and 2 is the only band left. The paper prints no sentence spelling that out because it does not need one — the cap is entailed by the criteria as published rather than asserted on top of them. It was previously flagged as this implementation's own on the mistaken view that a rule the paper never states in words must be an invention. WHAT THE SOURCE DOES LEAVE OPEN IS WHAT COUNTS AS SUPPORT. Table 1 gates those two bands on being on respiratory support and never defines the term, so this calculator's reading — invasive or non-invasive support both satisfy the gate, which is what the respiratory-support field accepts — is ours and not the paper's. A narrower reading, invasive ventilation only, is not ruled out by the source; under it a child on non-invasive support alone would cap at 2 where this calculator allows 3 or 4. The cap argument above is unaffected either way, because it turns on which bands are gated and not on what counts as support. DO NOT CARRY THE CAP ACROSS TO OTHER SCORES: Phoenix is structured the opposite way in the same situation. There a patient on no respiratory support scores 0 on the respiratory criterion however low the ratio goes, and even 1 point requires at least non-invasive support — so the same child can be pSOFA respiratory 2 and Phoenix respiratory 0 at once. Two scores, two structures; a reader moving between them should not assume that the ratio alone means the same thing in both. THAT CONTRAST IS NOW SOURCED FROM PHOENIX'S OWN PUBLISHED CODE rather than inferred from comparing two printed tables. The Phoenix task force publishes the SQL: it derives a single support flag — true when FiO₂ exceeds 0.21 or the child is invasively ventilated — and multiplies its ratio tiers by that flag, so the floor at 0 is explicit in their code exactly as the ceiling at 2 is entailed by pSOFA's table. The mechanism is the difference: Phoenix multiplies every tier by a support flag, pSOFA attaches a support condition only to its top two bands. Neither is to be harmonised to the other, and a reader comparing the two numbers is looking at a documented divergence between instruments, not at a disagreement about the child. HIGH-FLOW NASAL CANNULA IS WHERE THIS BITES IN PRACTICE. Phoenix counts high flow explicitly as respiratory support, and it falls inside the broad reading used here, so a child on high flow satisfies the support gate on both scores. The major paediatric registries go the other way: PICANet and ANZPIC both EXCLUDE high-flow nasal cannula from the mechanical-ventilation field they collect. The same child is therefore ‘supported’ for both of these scores and ‘not ventilated’ in either registry — which matters as soon as a score is read next to registry-derived case-mix or ventilation figures. What has NOT been retrieved, and must not be assumed: no cohort has quantified how much choosing CPAP over high flow, or counting high flow on one side and not the other, shifts the distribution of either score. The direction is obvious; the magnitude is unknown. The second rule that is genuinely this implementation's is likewise a documented choice, and this one is forced by the source: the published SpO₂:FiO₂ bands overlap, because JAMA Pediatr Table 1 prints 264 as both the lower bound of the subscore-1 row and the upper bound of the subscore-2 row, so the table assigns an exact 264 to two rows at once; this calculator resolves it to the worse subscore (2), in keeping with pSOFA's worst-value rule. SpO₂:FiO₂ is used only when no PaO₂ is available and only at SpO₂ ≤97%; that ceiling is the paper's own (Table 1 footnote) and matches the window the ratio was derived over, SpO₂ 80–97% in Khemani 2009 and 2012. An SpO₂ >97% with no PaO₂ scores respiratory 0. Matics & Sanchez-Pinto specify no physiologic plausibility bounds for PaO₂, platelets, bilirubin, MAP or creatinine — confirmed absent from the paper, not merely unlocated — so the min/max on those inputs are this platform's input-validity windows and carry no clinical meaning; prefer institutional analyzer limits. THAT REMAINS TRUE OF THE PAPER, BUT THE WINDOWS ARE NO LONGER UNCHECKABLE. Published plausibility ranges for the same analytes exist elsewhere, and every bound here has now been compared against them. Identical to a published range: FiO₂ 0.21–1.00, SpO₂ 0–100, and GCS 3–15, all three matching the reasonable-value table published in the Phoenix implementation notes — the SpO₂ match arriving with the published statement that a value above 97 is unusable for an SpO₂:FiO₂ ratio, which is the same ≤97% gate applied here and reaches it from a source independent of this paper's own Table 1 footnote. Narrower here than any published range, and DELIBERATELY UNCHANGED: PaO₂ 20–600 against a published range open above (and PICANet's tighter 3–60 kPa, 22–450 mmHg); MAP 10–150 against 1–300; creatinine 0.1–20 against 0–50; bilirubin 0.1–50 against a published total bilirubin range of 0–100; platelets 1–1000 against a range with no upper bound at all. NO BOUND ON THIS SCORE MOVED as a result — a form field refusing a typo does a different job from a data pipeline's outlier filter, and every window here already sits well outside the highest cut point it has to admit. One bound is deliberately WIDER than a published one and must stay so: age runs to 250 months here, where Phoenix declares [0, 216); that is Phoenix's eligibility domain, not a plausibility bound, and pSOFA's cohort ran to 252 months with a top band of >216, so importing 216 would refuse adolescents this score was derived on. The four vasoactive infusion-rate windows have no published comparator of any kind — the only published figure for vasoactive support in this family is Phoenix's count of distinct agents, integer 0–6, which is a different quantity. Second published comparator, from a different tradition: the PICANet Admission Dataset Definitions Manual v5.4 (November 2020), which publishes collection ranges including PaO₂ 3–60 kPa (22–450 mmHg), lactate 0.2–15.0 mmol/L, systolic pressure 20–180 with a check above 200, and base excess −30 to +20; no newer PICANet manual exists, confirmed. Provenance, so it is not overclaimed: the Phoenix reasonable-value table was read from that package's implementation-notes documentation, and the machine-readable units file that page refers to could not be retrieved, so nothing here is cited to that file. AND THE SILENCE ELSEWHERE IS ITSELF A FINDING: VPS, PC4 and PHIS publish NO public numeric plausibility or edit-check bounds — confirmed negative, theirs being proprietary rules behind login. That is why independent implementations of the same score disagree about what they will accept: for most inputs there is no public standard to converge on. Age: pSOFA was derived in children 21 years and younger, and the paper states that the >216-month MAP and creatinine cut points are identical to adult SOFA's, so a patient over 216 months is being scored against adult thresholds rather than paediatric ones. Neonates: the <1-month band exists, so pSOFA is defined rather than undefined there, but it was not derived in that population; nSOFA (Wynn & Polin, Pediatr Res 2020; a 0–15 scale) is the score derived for preterm very-low-birth-weight infants with late-onset sepsis. The >8 interpretation cut point is a single-center, statistically-derived threshold on the encounter maximum pSOFA and is descriptive, not directive.