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Scoring Systems for Organ Dysfunction and Multiple Organ Dysfunction: The PODIUM Consensus Conference
Luregn J Schlapbach1,2,3, Scott L Weiss4,3, Melania M Bembea5
1Children's Research Center and Department of Intensive Care and Neonatology, University Children's Hospital Zurich, Zurich, Switzerland.
Insights
Multiple pediatric organ dysfunction scoring systems exist, but their performance varies widely. A need for unified, data-driven criteria for critically ill children is indicated.
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Assessment Tools
- Biostatistics
Background:
- Multiple scoring systems are available to assess organ dysfunction in children.
- These scores aim to estimate illness severity in critically ill pediatric patients.
Purpose of the Study:
- To review existing literature on multiple organ dysfunction (MOD) scoring systems in critically ill children.
- To characterize the performance of these tools in assessing organ dysfunction and patient outcomes.
Main Methods:
- Conducted electronic literature searches of PubMed and Embase (January 1992–January 2020).
- Included studies evaluating critically ill children with MOD, assessing scoring tool performance, and analyzing patient outcomes.
- Data abstraction performed by a task force member.
Main Results:
- 54 eligible studies were identified from 1152 unique abstracts.
- Commonly reported scores included Pediatric Logistic Organ Dysfunction (PELOD) and pediatric Sequential Organ Failure Assessment (pSOFA).
- Significant variation was observed in criteria, diagnostic elements, and scoring methodologies.
Conclusions:
- Scores generally showed increased mortality with greater organ dysfunction.
- The performance characteristics of existing scores varied considerably.
- There is a clear need for unified, data-driven organ dysfunction criteria validated in diverse international populations of critically ill children.
Context:
Multiple scores exist to characterize organ dysfunction in children.
Objective:
To review the literature on multiple organ dysfunction (MOD) scoring systems to estimate severity of illness and to characterize the performance characteristics of currently used scoring tools and clinical assessments for organ dysfunction in critically ill children.
Data Sources:
Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020.
Study Selection:
Studies were included if they evaluated critically ill children with MOD, evaluated the performance characteristics of scoring tools for MOD, and assessed outcomes related to mortality, functional status, organ-specific outcomes, or other patient-centered outcomes.
Data Extraction:
Data were abstracted into a standard data extraction form by a task force member.
Results:
Of 1152 unique abstracts screened, 156 full text studies were assessed including a total of 54 eligible studies. The most commonly reported scores were the Pediatric Logistic Organ Dysfunction Score (PELOD), pediatric Sequential Organ Failure Assessment score (pSOFA), Pediatric Index of Mortality (PIM), PRISM, and counts of organ dysfunction using the International Pediatric Sepsis Definition Consensus Conference. Cut-offs for specific organ dysfunction criteria, diagnostic elements included, and use of counts versus weighting varied substantially.
Limitations:
While scores demonstrated an increase in mortality associated with the severity and number of organ dysfunctions, the performance ranged widely.
Conclusions:
The multitude of scores on organ dysfunction to assess severity of illness indicates a need for unified and data-driven organ dysfunction criteria, derived and validated in large, heterogenous international databases of critically ill children.
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