Developing organ dysfunction diagnostic criteria for children with cancer and post-hematopoietic cell
Michael Bashir1, Sayeda Islam2, Jordan Wrigley3
1Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, United States.
Insights
The Pediatric Organ Dysfunction Information Update Mandate (PODIUM) criteria may misclassify organ dysfunction in pediatric cancer patients. This study protocol aims to develop adapted criteria (PODIUM-Onc) for improved accuracy in this vulnerable population.
Area of Science:
- Pediatric critical care medicine
- Oncology
- Hematopoietic cell transplantation and cellular therapy
Background:
- The Pediatric Organ Dysfunction Information Update Mandate (PODIUM) criteria are used for critically ill children.
- These criteria may inaccurately assess organ dysfunction in pediatric oncology and post-hematopoietic cell transplantation/cellular therapy (HCT/CAR) patients.
- Differences in etiology, pathophysiology, and risk factors necessitate tailored criteria for these populations.
Purpose of the Study:
- To systematically review the performance of PODIUM criteria in pediatric oncology and post-HCT/CAR patients.
- To identify evidence-based criteria for organ dysfunction predicting adverse outcomes in these specific groups.
- To develop adapted consensus criteria (PODIUM-Onc) for organ dysfunction in pediatric cancer and post-HCT/CAR patients.
Main Methods:
- Conduct a systematic literature review of studies published since January 1, 2004.
- Utilize multiple databases including MEDLINE, CINAHL, EMBASE, and Web of Science.
- Include original studies in children (0-21 years) undergoing cancer treatment or post-HCT/CAR, excluding studies with limited data or small sample sizes.
Main Results:
- Data extraction will encompass study, hospital, and patient characteristics, outcomes, and risk of bias.
- Analysis will focus on organ-specific factors associated with patient outcomes.
- Findings will inform the development of adapted consensus criteria through a modified Delphi process.
Conclusions:
- The study aims to create clinically relevant consensus criteria (PODIUM-Onc) for organ dysfunction in pediatric oncology and post-HCT/CAR patients.
- These adapted criteria will enhance the accuracy of organ dysfunction classification.
- The developed criteria will guide clinical care and support future research in this high-risk population.
Background:
The Pediatric Organ Dysfunction Information Update Mandate (PODIUM) proposed consensus criteria to define organ dysfunction in critically ill children. However, utilization of the PODIUM criteria in pediatric oncology patients and those who have received hematopoietic cell transplantation or cellular therapy (post-HCT/CAR) may inaccurately classify organ dysfunction in these patients due to differences in organ dysfunction etiology, pathophysiology, and risk factors for adverse outcomes. To address this gap, we report a study protocol to systematically review the performance of the PODIUM criteria for pediatric cancer and/or those treated with HCT and determine if adjustments are needed.
Objective:
The objectives of this study will be to [1] identify evidence-based criteria for organ dysfunction predicting adverse outcomes among pediatric oncology and post-HCT patients, [2] use these findings to inform adapted consensus criteria (PODIUM-Onc) for organ dysfunction tailored to this high-risk population through a multidisciplinary modified Delphi process, and [3] describe knowledge gaps to guide future research.
Data Source And Search Strategy:
We will perform a systematic literature review of studies published since January 1, 2004, using the following databases: MEDLINE (via PubMed), CINAHL (via EBSCO), EMBASE (via Elsevier), and Web of Science (via Clarivate). Search results will be filtered using a pediatric search hedge and further refined to children (0 to 21 years old) during or up to 1 year after treatment for cancer or HCT/CAR for malignancy. Publications without original data (e.g., comments, editorials, letters, notes, conference materials), studies with ≤ 10 patients, and those preceding January 1, 2004, will be excluded.
Study Selection:
We will include original studies in any language published since January 1, 2004, that meet all eligibility criteria and for which a full text is available.
Data Extraction:
Data extraction will include information related to study characteristics, hospital characteristics, underlying population characteristics, patient population characteristics, and outcomes.
Data Synthesis:
We will extract and report data on the study, hospital, and patient characteristics, outcomes, and risk of bias.
Conclusion:
By systematically reviewing and analyzing organ-specific factors associated with patient outcomes and synthesizing these findings through a modified Delphi consensus process, we aim to create consensus criteria that will be clinically relevant for pediatric oncology patients and HCT patients. These criteria will provide a foundation to guide clinical care and to support future research in this vulnerable patient population.
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