title: Daily estimation of the severity of multiple organ dysfunction syndrome in critically ill children.
abstract: BACKGROUND
  Daily evaluation of multiple organ dysfunction syndrome has been performed in critically ill adults. We evaluated the clinical course of multiple organ dysfunction over time in critically ill children using the Pediatric Logistic Organ Dysfunction (PELOD) score and determined the optimal days for measuring scores.
  
  
  METHODS
  We prospectively measured daily PELOD scores and calculated the change in scores over time for 1806 consecutive patients admitted to seven pediatric intensive care units (PICUs) between September 1998 and February 2000. To study the relationship between daily scores and mortality in the PICU, we evaluated changes in daily scores during the first four days; the mean rate of change in scores during the entire PICU stay between survivors and nonsurvivors; and Cox survival analyses using a change in PELOD score as a time-dependent covariate to determine the optimal days for measuring daily scores.
  
  
  RESULTS
  The overall mortality among the 1806 patients was 6.4%. A high PELOD score (>or=20 points) on day 1 was associated with an odds ratio (OR) for death of 40.7 (95% confidence interval [CI] 20.3-81.4); a medium score (10-19 points) on day 1 was associated with an OR for death of 4.2 (95% CI 2.0-8.7). Mortality was 50% when a high score on day 1 increased on day 2. The course of daily PELOD scores differed between survivors and nonsurvivors. A set of seven days (days 1, 2, 5, 8, 12, 16 and 18) was identified as the optimal period for measurement of daily PELOD scores.
  
  
  CONCLUSIONS
  PELOD scores indicating a worsening condition or no improvement over time were indicators of a poor prognosis in the PICU. A set of seven days for measurement of the PELOD score during the PICU stay provided optimal information on the progression of multiple-organ dysfunction syndrome in critically ill children.
authors.affiliation: Pediatric Intensive Care Unit, the Department of Biostatistics, Université Lille Nord de France, UDSL, EA 2694, Centre hospitalier universitaire Lille, Lille, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Leteurtre
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.forename: Bruno
authors.initials: B
authors.lastname: Grandbastien
authors.forename: François
authors.initials: F
authors.lastname: Proulx
authors.forename: Jacques
authors.initials: J
authors.lastname: Cotting
authors.forename: Ronald
authors.initials: R
authors.lastname: Gottesman
authors.forename: Ari
authors.initials: A
authors.lastname: Joffe
authors.forename: Bendicht
authors.initials: B
authors.lastname: Wagner
authors.forename: Philippe
authors.initials: P
authors.lastname: Hubert
authors.forename: Alain
authors.initials: A
authors.lastname: Martinot
authors.forename: Jacques
authors.initials: J
authors.lastname: Lacroix
authors.forename: Francis
authors.initials: F
authors.lastname: Leclerc
mesh_terms: D000328:Adult; D016638:Critical Illness; D018450:Disease Progression; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D016015:Logistic Models; D009102:Multiple Organ Failure / Q000145:classification* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index