ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Critical Care
Change in Vasoactive Inotropic Score Following Hydrocortisone Administration in the Pediatric Intensive Care Unit: a PICU Data Collaborative Study, 2010-2022
Colin Michael Rogerson 1
Stephanie R Brown 2
Colleen Marie Badke 3
Adam Dziorny 4
Reid WD. Farris 5
Tellen D. Bennett 6
Daniel Tawfik 7
Tim T. Cornell 7
Randall C Wetzel 8
Akira Nishisaki 9
Julia A. Heneghan 10
1. School of Medicine, Indiana University Bloomington, Indianapolis, United States
2. Emory University School of Medicine, Atlanta, United States
3. Northwestern University Feinberg School of Medicine, Chicago, United States
4. University of Rochester School of Medicine and Dentistry, Rochester, United States
5. University of Washington School of Medicine, Seattle, United States
6. University of Colorado Anschutz Medical Campus School of Medicine, Aurora, United States
7. Stanford University School of Medicine, Stanford, United States
8. University of Southern California Keck School of Medicine, Los Angeles, United States
9. University of Pennsylvania Perelman School of Medicine, Philadelphia, United States
10. University of Minnesota Twin Cities Medical School, Minneapolis, United States
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Abstract
Objective: Hydrocortisone (HCT) is an ancillary therapy for children with refractory hypotension. Recent guidelines for HCT use are non-specific due to lack of evidence of efficacy. We evaluated the current practice patterns and association of HCT on the vasoactive inotropic score (VIS) in children in the Pediatric Intensive Care unit. Materials and Methods: This was a retrospective observational cohort study using the PICU Data Collaborative (PDC). Our cohort consisted of PDC encounters receiving at least one of the six vasoactive medications included in the VIS calculation (Epinephrine, Norepinephrine, Dopamine, Dobutamine, Vasopressin, or Milrinone). We calculated hourly VIS for the first 7 days of ICU admission. We conducted a propensity score matched comparison of change in VIS from hours 24-48 between encounters receiving HCT in the first 24 hours of ICU admission and controls who did not receive HCT. Measurements and Main Results: Our cohort included 10,244 encounters from 3 institutions. Of these, 1,915 (18.7%) received HCT. Encounters receiving HCT were older (5.4 [0.8-13.8] years vs. 4.3 [0.6-13.3] years respectively) and had a higher maximum VIS (15.0 [10.0-20.2] vs. 8.0 [5.0-13.0]). The PICU cohort had a significantly greater decrease in VIS from 24 hours to 48 hours after admission compared to the CVICU cohort (82.2% [-40%-100%] vs. 16.2% [4.0%- 100%]; p<0.01). In the matched PICU cohort, there was no difference in the 24-hour reference VIS, however, there was a greater decrease in percentage of VIS from the 24-hour reference to 48 hours for those who received HCT (100.0 [50.0-100.0] vs. 86.6 (0.0-100.0); p=0.03). In the matched CVICU cohort, the HCT group had a higher VIS at 24 hours (7.7 [1.0-11.0] vs. 6.0 [0.0-10.0]; p=0.02), with smaller decreases in VIS percent from reference at 48 hours (9.3 [-13.2-58.7] vs. 18.2 [0.0-80.0]; p=0.01). Conclusions: The use of HCT was associated with greater improvement in VIS between 24-48 hours after admission for children in the PICU, but not for children in the CVICU. Further research is needed to determine the optimal patient selection and timing of HCT use.
Summary
Keywords
Critical Care, Informatics, Pediatrics, Resuscitation, Shock
Received
07 November 2025
Accepted
20 February 2026
Copyright
© 2026 Rogerson, Brown, Badke, Dziorny, Farris, Bennett, Tawfik, Cornell, Wetzel, Nishisaki and Heneghan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Colin Michael Rogerson
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