Multiple organ dysfunction syndrome in critically ill children: clinical value of two lists of diagnostic criteriaReport as inadecuate




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Annals of Intensive Care

, 6:40

First Online: 29 April 2016Received: 14 December 2015Accepted: 12 April 2016

Abstract

BackgroundTwo sets of diagnostic criteria of paediatric multiple organ dysfunction syndrome MODS were published by Proulx in 1996 and by Goldstein in 2005. We hypothesized that this changes the epidemiology of MODS. Thus, we determined the epidemiology of MODS, according to these two sets of diagnostic criteria, we studied the intra- and inter-observer reproducibility of each set of diagnostic criteria, and we compared the association between cases of MODS at paediatric intensive care unit PICU entry, as diagnosed by each set of diagnostic criteria, and 90-day all-cause mortality.

MethodsAll consecutive patients admitted to the tertiary care PICU of Sainte-Justine Hospital, from April 21, 2009 to April 20, 2010, were considered eligible for enrolment into this prospective observational cohort study. The exclusion criteria were gestational age < 40 weeks, age < 3 days or > 18 years at PICU entry, pregnancy, admission immediately after delivery. No patients were censored. Daily monitoring using medical chart ended when the patient died or was discharged from PICU. Mortality was monitored up to death, hospital discharge, or 90 days post PICU entry, whatever happened first. Concordance rate and kappa score were calculated to assess reproducibility. The number of MODS identified with Proulx and Goldstein definitions was compared using 2-by-2 contingency tables. Student’s t test or Wilcoxon signed-ranked test was used to compare continuous variables with normal or abnormal distribution, respectively. We performed a Kaplan–Meier survival analysis to assess the association between MODS at PICU entry and 90-day mortality.

ResultsThe occurrence of MODS was monitored daily and prospectively in 842 consecutive patients admitted to the PICU of Sainte-Justine Hospital over 1 year. According to Proulx and Goldstein diagnostic criteria, 180 21.4 % and 314 patients 37.3 % had MODS over PICU stay, respectively. Concordance of MODS diagnosis over PICU stay was 81.3 % 95 % CI 78.6–83.9 %, and kappa score was 0.56 95 % CI 0.50–0.61. Discordance was mainly attributable to cardiovascular or neurological dysfunction criteria. The proportion of patients with MODS at PICU entry who died within 90 days was higher with MODS diagnosed with Proulx criteria 17.8 vs. 11.5 %, p = 0.038, as well as the likelihood ratio of death 4.84 vs. 2.37. On the other hand, 90-day survival rate of patients without MODS at PICU entry was similar 98.6 vs. 98.9 % p = 0.73.

ConclusionsProulx and Goldstein diagnostic criteria of paediatric MODS are not equivalent. The epidemiology of paediatric MODS varies depending on which set of diagnostic criteria is applied.

KeywordsCritical care Diagnosis Intensive care Mortality Multiple organ failure Paediatric AbbreviationsaPTTactivated partial thromboplastin time

ARDSacute respiratory distress syndrome

CIconfidence interval

ECMOextracorporeal membrane oxygenation

ICUintensive care unit

MODSmultiple organ dysfunction syndrome

ORodds ratio

PELODpaediatric logistic organ dysfunction

PICUpaediatric ICU

PRISMpaediatric risk of mortality

PTprothrombin time

Electronic supplementary materialThe online version of this article doi:10.1186-s13613-016-0144-6 contains supplementary material, which is available to authorized users.

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Author: Andréanne Villeneuve - Jean-Sébastien Joyal - François Proulx - Thierry Ducruet - Nicole Poitras - Jacques Lacroix

Source: https://link.springer.com/



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