Pediatric Cutaneous Risk Score: Early Skin-Based Prediction of Multi-Organ Failure in Critically Ill Children

Pediatric Cutaneous Risk Score in PICU

Abstract

Life-threatening pediatric dermatologic emergencies—including Stevens–Johnson syndrome/toxic epidermal necrolysis, necrotizing soft tissue infections, and severe drug-induced cutaneous reactions—carry substantial risk of multi-organ failure (MOF) and death in the pediatric intensive care unit (PICU). Early risk stratification is difficult because commonly used prognostic tools depend on laboratory or organ-based parameters that may not be immediately available. We aimed to identify readily observable cutaneous predictors of early systemic deterioration and to develop and internally validate a simple bedside Pediatric Cutaneous Risk Score (pCRS) to predict MOF and PICU mortality in critically ill children with dermatologic emergencies.

We conducted a retrospective, multicenter cohort study across two tertiary PICUs (January 2018–December 2023) that included 50 consecutive patients aged 0–18 years. The primary outcome was MOF, defined as PELOD-2 ≥11 within 48 hours; the secondary outcome was PICU mortality. Multivariable logistic regression (model limited to three pre-specified predictors) identified three independent cutaneous predictors: body surface area involvement >30% (OR 5.6; 95% CI 2.1–14.9), purpura (OR 4.2; 95% CI 1.6–10.9), and mucosal involvement at ≥2 sites (OR 3.8; 95% CI 1.2–12.1). Each predictor was assigned 1 point (pCRS 0–3), with stepwise mortality increasing from 0% (0 points) to 75% (3 points). The pCRS showed excellent discrimination for mortality (AUC 0.87; optimism-corrected AUC 0.85 after 1,000 bootstrap resamples). This rapid, reproducible score may support early bedside triage and resource allocation in PICU, pending external validation.