Daily estimation of the severity of multiple organ dysfunction syndrome in critically ill children.
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.
Leteurtre
Stéphane
S
Pediatric Intensive Care Unit, the Department of Biostatistics, Université Lille Nord de France, UDSL, EA 2694, Centre hospitalier universitaire Lille, Lille, France.
Duhamel
Alain
A
Grandbastien
Bruno
B
Proulx
François
F
Cotting
Jacques
J
Gottesman
Ronald
R
Joffe
Ari
A
Wagner
Bendicht
B
Hubert
Philippe
P
Martinot
Alain
A
Lacroix
Jacques
J
Leclerc
Francis
F
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