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Epidemiology and outcomes of multiple organ dysfunction syndrome following pediatric trauma
Elizabeth Y Killien1, Jana M Zahlan, Hetal Lad
1From the Harborview Injury Prevention and Research Center (E.Y.K., J.M.Z., H.L., M.S.V., R.L.N.H., F.P.R.), Division of Pediatric Critical Care Medicine, Department of Pediatrics, (E.Y.K., R.S.W.), University of Washington; Center for Child Health, Behavior, and Development (E.Y.K., R.S.W., F.P.R.), Seattle Children's Research Institute; Department of Anesthesiology and Pain Medicine (M.S.V.), University of Washington, Seattle, Washington; University Medical Center Utrecht (R.L.N.H.), Utrecht, Netherlands; and Division of General Pediatrics, Department of Pediatrics (F.P.R.), University of Washington, Seattle, Washington.
Insights
Multiple organ dysfunction syndrome (MODS) is more common in pediatric trauma patients than previously thought, significantly increasing mortality risk. Early identification of organ dysfunction is crucial for improving outcomes in critically injured children.
Area of Science:
- Pediatric Critical Care Medicine
- Trauma Surgery
- Epidemiology
Background:
- Previous studies underestimated Multiple Organ Dysfunction Syndrome (MODS) prevalence in pediatric trauma by using adult criteria.
- This study utilized pediatric-specific criteria for a more accurate assessment in a large national cohort.
Purpose of the Study:
- To determine the prevalence, risk factors, and outcomes of MODS in critically injured children using a national pediatric intensive care unit (PICU) database.
- To apply pediatric criteria for MODS identification and analyze its association with mortality and functional outcomes.
Main Methods:
- Retrospective cohort study of 37,177 pediatric trauma patients (1 month–17 years) from the Virtual Pediatric Systems, LLC database (2009–2017).
- MODS identified on Day 1 of PICU admission using International Pediatric Sepsis Consensus Conference criteria.
- Generalized linear Poisson regression adjusted for covariates to estimate risks of mortality and poor functional outcome.
Main Results:
- MODS was present in 23.1% of pediatric trauma patients on PICU Day 1.
- MODS was associated with a significantly higher risk of mortality (aRR 32.3) and poor functional outcome (aRR 4.3).
- Mortality increased with the number of dysfunctional organs, ranging from 1.5% (1 organ) to 69.1% (≥4 organs), with hematologic and renal dysfunction posing the highest risks.
Conclusions:
- MODS occurs more frequently in pediatric trauma than previously reported, carrying a high morbidity and mortality burden.
- The prevalence and mortality associated with MODS in trauma patients exceed those in the general PICU population.
- Integrating early organ dysfunction assessment with injury severity may enhance prognostication for pediatric trauma patients.
Background:
Existing studies have found a low prevalence of multiple organ dysfunction syndrome (MODS) in pediatric trauma patients, typically applying adult criteria to single-center pediatric cohorts. We used pediatric criteria to determine the prevalence, risk factors, and outcomes of MODS among critically injured children in a national pediatric intensive care unit (PICU) database.
Methods:
We conducted a retrospective cohort study of PICU patients 1 month to 17 years with traumatic injury in the Virtual Pediatric Systems, LLC database from 2009 to 2017. We used International Pediatric Sepsis Consensus Conference criteria to identify MODS on Day 1 of PICU admission and estimated the risk of mortality and poor functional outcome (Pediatric Overall/Cerebral Performance Category ≥3 with ≥1 point worsening from baseline) for MODS and for each type of organ dysfunction using generalized linear Poisson regression adjusted for age, comorbidities, injury type and mechanism, and postoperative status.
Results:
Multiple organ dysfunction syndrome was present on PICU Day 1 in 23.1% of 37,177 trauma patients (n = 8,592), with highest risk among patients with injuries associated with drowning, asphyxiation, and abuse. Pediatric intensive care unit mortality was 20.1% among patients with MODS versus 0.5% among patients without MODS (adjusted relative risk, 32.3; 95% confidence interval, 24.1-43.4). Mortality ranged from 1.5% for one dysfunctional organ system to 69.1% for four or more organ systems and was highest among patients with hematologic dysfunction (43.3%) or renal dysfunction (29.6%). Death or poor functional outcome occurred in 46.7% of MODS patients versus 8.3% of patients without MODS (adjusted relative risk, 4.3; 95% confidence interval 3.4-5.3).
Conclusion:
Multiple organ dysfunction syndrome occurs more frequently following pediatric trauma than previously reported and is associated with high risk of morbidity and mortality. Based on existing literature using identical methodology, both the prevalence and mortality associated with MODS are higher among trauma patients than the general PICU population. Consideration of early organ dysfunction in addition to injury severity may aid prognostication following pediatric trauma.
Level Of Evidence:
Prognostic and Epidemiological; Level III.
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