The Pediatric Multiple Organ Dysfunction Score (P-MODS): Development and validation of an objective scale to measure the severity of multiple organ dysfunction in critically ill children
The Pediatric Multiple Organ Dysfunction Score (P-MODS): Development and validation of an objective scale to measure the severity of multiple organ dysfunction in critically ill children
复制标题
DOI：
10.1097/01.ccm.0000170943.23633.47
复制
发表时间：
2005-07-01
影响因子：
8.8
通讯作者：
Giroir, BP
中科院分区：
文献类型：
--
作者：
Graciano, AL;Balko, JA;Giroir, BP
目的：设计：前瞻性、观察性队列研究，在一家三级护理儿科教学医院的儿科重症监护病房，对一个危重患儿群体进行多器官系统功能障碍的客观分级，并进行前瞻性验证。儿科连续入院共6,456例干预措施：a）确定可以定义儿童器官功能障碍的变量; B）开发儿科多器官功能障碍评分（P-MODS）; c）评分与儿科重症监护病房出院时结果的相关性; d）随后的前瞻性验证。测量和主要结果。计算机系统将患者随机分为两组：一组用于创建评分系统的开发组和一组用于评估评分性能和再现性的验证组。生存者和非生存者进行了比较，以确定变量，显着更异常的非生存者。这些变量与儿科重症监护病房死亡率相关。在开发集中定义每个变量的最佳区间，并在验证集中评价其性能。在五个器官系统中确定了器官功能障碍的描述符：心血管（乳酸）、呼吸（Pao（2）/Fio（2）比值）、肝脏（胆红素）、血液学（纤维蛋白原）和肾脏（血尿素氮）。每个变量的分级量表设定为0 - 4，分别对应于50%的死亡率< 5% and >。通过对所有变量的最差评分求和来计算P-MODS。通过生成两个研究集的受试者工作特征曲线来评价评分的总体表现，评分与儿科重症监护室死亡率密切相关，并呈分级方式。在两组（开发和验证）中，最高评分时的死亡率为< 5% when the score was 0 and >70%。总体死亡率为5.9%（开发集）和5.3%（验证集）。该评分显示出良好的区分力，反映在曲线下面积：0.81（开发集）和0.78（验证集）。P-MODS与儿科重症监护病房的死亡率密切相关，可以为评估儿科重症监护病房的器官功能障碍提供客观的指标。随着在许多中心的进一步研究和验证，P-MODS很可能作为未来治疗试验的定量、临床相关替代结局指标。
Objective: To develop and then prospectively validate an objective scale to grade multiple organ system dysfunction in a large population of critically ill children.Design: Prospective, observational cohort study.Setting: A pediatric intensive care unit at a tertiary care pediatric teaching hospital.Patients. A total of 6,456 pediatric consecutive admissions (mean age 4.62 yrs) admitted to the pediatric intensive care unit.Interventions: a) Identification of variables that could define organ dysfunction in children; b) development of a Pediatric Multiple Organ Dysfunction Score (P-MODS); c) correlation of the score with outcome at pediatric intensive care unit discharge; d) subsequent prospective validation.Measurements and Main Results. A computer system randomly separated patients into two groups: a development set to create the scoring system and a validation set to evaluate score performance and reproducibility. Survivors and nonsurvivors were compared to define variables that were significantly more abnormal in nonsurvivors. Those variables were correlated with pediatric intensive care unit mortality rate. Optimal intervals for each variable were defined on the development set, and their performance was evaluated in the validation set. Descriptors for organ dysfunction were identified in five organ systems: cardiovascular (lactic acid), respiratory (Pao(2)/Fio(2) ratio), hepatic (bilirubin), hematologic (fibrinogen), and renal (blood urea nitrogen). A grading scale for each variable was set from 0 to 4, corresponding to mortality rates of < 5% and > 50%, respectively. P-MODS was calculated by summing the worst score for all variables. Overall performance of the score was evaluated by generating receiver operating characteristic curves for both study sets.The score correlated strongly and in a graded fashion with pediatric intensive care unit mortality rate. In both sets (development and validation), mortality rate was < 5% when the score was 0 and > 70% at the highest score. Overall mortality rate was 5.9% (development set) and 5.3% (validation set). The score showed excellent discrimination reflected in areas under the curve: 0.81 (development set) and 0.78 (validation set).Conclusions., P-MODS correlated strongly with pediatric intensive care unit mortality in both study sets and can provide an objective measure for assessing organ dysfunction in the pediatric intensive care unit. With further study and validation across many centers, it is likely that P-MODS could function as a quantitative, clinically relevant surrogate outcome measure for future therapeutic trials.