Patterns of Organ Dysfunction in Critically Ill Children Based on PODIUM Criteria

Area of Science:

• Critical Care Medicine
• Pediatric Health
• Health Informatics

Background:

• Accurate identification of organ dysfunction is crucial for critically ill children.
• Existing criteria for pediatric organ dysfunction have limitations in electronic health record (EHR) data.
• The Pediatric Organ Dysfunction Information Update Mandate (PODIUM) criteria offer a potential alternative for EHR-based research.

Purpose of the Study:

• To evaluate the incidence, prognostic performance, and generalizability of PODIUM criteria using EHR data.
• To compare the performance of PODIUM criteria against the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) criteria.

Main Methods:

• A retrospective observational cohort study included over 22,000 pediatric intensive care unit (PICU) admissions across two US medical centers (2010-2018).
• Organ dysfunction was assessed using PODIUM and IPSCC criteria for each 24-hour period up to 28 days post-admission.
• The prognostic performance of both criteria for discriminating in-hospital mortality was analyzed.

Main Results:

• The cumulative incidence of PODIUM organ dysfunction ranged from 15% to 30%, with associated in-hospital mortality of 6% to 10%.
• The number of concurrent PODIUM organ dysfunctions showed good-to-excellent discrimination for in-hospital mortality (AUC 0.87-0.93).
• PODIUM criteria performed favorably compared to IPSCC criteria (AUC 0.84-0.92).

Conclusions:

• This study provides the first evaluation of PODIUM criteria in EHR databases, indicating their potential utility.
• PODIUM criteria appear promising for epidemiologic and clinical research utilizing EHR data.
• Further research is needed to assess PODIUM criteria for data not routinely structured in EHRs.