Pediatric Logistic Organ Dysfunction Score (PELOD) System

Description

Leteurtre et al developed the PEdiatric Logistic Organ Dysfunction (PELOD) scoring system for evaluating critically ill children in pediatric ICUs. It evaluates 6 key organ systems using 12 clinical or laboratory measure. This can be used to estimate the mortality risk for the child. The authors are from multiple institutions in Lille, Montreal and Paris.

The 6 organ systems with the 12 measures:

(1) neurologic (Glasgow Coma Score, or GCS; pupillary reactions)

(2) cardiovascular (systolic blood pressure; heart rate)

(3) renal (serum creatinine)

(4) pulmonary (PaO2 to FIO2 ratio; PaO2; mechanical ventilation)

(5) hematologic (platelet count; WBC count)

(6) hepatic (SGOT = AST; prothrombin time)

NOTES:

(1) If a parameter is measured more than once in a 24 hour period, then the most abnormal value is used to calculate the score.

(2) If the patient is sedated, the estimated GCS prior to sedation is used.

(3) Ventilation by mask did not qualify for mechanical ventilation.

Parameter	Finding	Points
neurological score	GCS 12-15 AND both pupils reactive	0
	GCS 7 – 11	1
	GCS 4 – 6 OR both pupils fixed	10
	GCS 3	20
cardiovascular	age < 1 month AND heart rate <= 195 beats/min AND systolic blood pressure > 65 mm Hg	0
	(age >= 1 month AND age < 1 year) AND heart rate <= 195 beats/min AND systolic blood pressure > 75 mm Hg	0
	(age >= 1 year AND age < 12 years) AND heart rate <= 195 beats/min AND systolic blood pressure > 85 mm Hg	0
	age >= 12 years AND heart rate <= 150 beats/min AND systolic blood pressure > 95 mm Hg	0
	age < 1 month AND (heart rate > 195 beats/min OR (systolic blood pressure >= 35 AND <= 65 mm Hg))	10
	(age >= 1 month AND age < 1 year) AND (heart rate > 195 beats/min OR (systolic blood pressure >= 35 AND <= 75 mm Hg))	10
	(age >= 1 year AND age < 12 years) AND (heart rate > 195 beats/min OR (systolic blood pressure >= 45 AND <= 85 mm Hg))	10
	age >= 12 years AND (heart rate > 150 beats/min OR (systolic blood pressure >= 55 AND <= 95 mm Hg))	10
	age < 1 month AND systolic blood pressure < 35 mm Hg	20
	(age >= 1 month AND age < 1 year) AND systolic blood pressure < 35 mm Hg	20
	(age >= 1 year AND age < 12 years) AND systolic blood pressure < 45 mm Hg	20
	age >= 12 years AND systolic blood pressure < 55 mm Hg	20
renal	age < 7 days AND creatinine < 1.59 mg/dL	0
	age >= 7 days AND age < 1 year AND creatinine < 0.62 mg/dL	0
	age >= 1 year AND <12 years AND creatinine < 1.13 mg/dL	0
	age >= 12 years AND creatinine < 1.59 mg/dL	0
	age < 7 days AND creatinine >= 1.59 mg/dL	10
	age >= 7 days AND age < 1 year AND creatinine >= 0.62 mg/dL	10
	age >= 1 year AND <12 years AND creatinine >= 1.13 mg/dL	10
	age >= 12 years AND creatinine >= 1.59 mg/dL	10
pulmonary	PaO2 to FIO2 ratio > 70 mm Hg AND PaCO2 <= 90 mm Hg AND no mechanical ventilation	0
	mechanical ventilation	1
	PaO2 to FIO2 ratio <= 70 mm Hg OR PaCO2 > 90 mm Hg	10
hematologic	WBC count >= 4,500 per µL AND platelet count >= 35,000 per µL	0
	(WBC count >= 1,500 per µL AND < 4,400 per µL) OR platelet count < 35,000 per µL	1
	WBC count < 1,500 per µL	10
hepatic	SGOT (AST) < 950 IU/L AND prothrombin time > 60%	0
	SGOT (AST) >= 950 IU/L OR prothrombin time <= 60%	1

after Table 7, page 406

where:

• "Prothrombin time" appears to refer to the Quick Test. This is not usually performed in the US. It requires plotting dilutions of normal plasma vs clotting times. From what I can read, a 60% level probably is about 18 seconds. I would prefer using the INR.

PELOD score =

= SUM(points for the 6 parameters)

X =

= (0.30 * (PELOD score)) – 7.64

probability of mortality –

= 1 / (1 + EXP((-1) * X))

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Description

Specialty

Objective

ICD-10

Pediatric Logistic Organ Dysfunction (PELOD) System

Purpose: To predict the mortality of a pediatric patient requiring intensive care using the PELOD system.

Description

Specialty

Objective

ICD-10