Abstract
Prior criteria for organ dysfunction in critically ill children were based mainly on expert opinion. We convened the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) expert panel to summarize data characterizing single and multiple organ dysfunction and to derive contemporary criteria for pediatric organ dysfunction. The panel was composed of 88 members representing 47 institutions and 7 countries. We conducted systematic reviews of the literature to derive evidence-based criteria for single organ dysfunction for neurologic, cardiovascular, respiratory, gastrointestinal, acute liver, renal, hematologic, coagulation, endocrine, endothelial, and immune system dysfunction. We searched PubMed and Embase from January 1992 to January 2020. Study identification was accomplished using a combination of medical subject headings terms and keywords related to concepts of pediatric organ dysfunction. Electronic searches were performed by medical librarians. Studies were eligible for inclusion if the authors reported original data collected in critically ill children; evaluated performance characteristics of scoring tools or clinical assessments for organ dysfunction; and assessed a patient-centered, clinically meaningful outcome. Data were abstracted from each included study into an electronic data extraction form. Risk of bias was assessed using the Quality in Prognosis Studies tool. Consensus was achieved for a final set of 43 criteria for pediatric organ dysfunction through iterative voting and discussion. Although the PODIUM criteria for organ dysfunction were limited by available evidence and will require validation, they provide a contemporary foundation for researchers to identify and study single and multiple organ dysfunction in critically ill children.
| Original language | English (US) |
|---|---|
| Pages (from-to) | S1-S12 |
| Journal | Pediatrics |
| Volume | 149 |
| Issue number | Supplement_1 |
| DOIs | |
| State | Published - Jan 1 2022 |
Bibliographical note
Funding Information:Despite its paramount importance in the practice of pediatric critical care, clinicians and researchers have relied on historical expert consensus definitions of organ dysfunctions that were derived in 2004 for the conduct of the Researching Severe Sepsis and Organ Dysfunction in Children: A Global Perspective (RESOLVE) trial of activated protein C (Xigris; Eli Lily) for pediatric septic shock.17 Results of this consensus conference were published in 2005 as a supplement to Pediatric Critical Care Medicine, which is the most frequently cited reference for this journal.18 Accordingly, on March 26–27, 2015, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) convened a group of nearly 30 experts (clinicians, basic scientists, bioengineers, and others) in Rockville, Maryland, to discuss a research agenda for pediatric MODS with an ultimate goal of improving outcomes for children who experience this common syndrome. The workshop was sponsored by the Office of Science Policy, Analysis, and Communication of the NICHD. A summary of this first Pediatric MODS Workshop was subsequently published as a supplement to Pediatric Critical Care Medicine in 2017.19
Funding Information:
FUNDING: Publication costs for this manuscript were supported by the Johns Hopkins University Discovery Award to Dr Bembea, The Richard J. Traystman Endowed Chair at the Johns Hopkins University, and Seattle Children’s Hospital. This work was supported by National Institutes of Health, National Institute of Neurological Disorders and Stroke, grant R01 NS106292 to Dr Bembea. Funded by the National Institutes of Health (NIH).
Publisher Copyright:
Copyright © 2022 by the American Academy of Pediatrics
PubMed: MeSH publication types
- Consensus Development Conference
- Journal Article
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
