Wilkinson et al evaluated pediatric patients in the intensive care unit for organ system failures and sepsis. This can help identify high risk patients who may benefit from more aggressive management. The authors are from New York Hospital - Cornell Medical Center, George Washington University, University of Texas Health Science Center at Houston, State University of New York Syracuse, University of New Mexico and Medical College of Georgia.
Organ systems:
(1) cardiovascular
(2) respiratory
(3) neurologic
(4) hematologic
(5) renal
(6) gastrointestinal
(7) hepatic
|
Organ System |
Measure |
|
cardiovascular |
mean arterial pressure (< 40 mm Hg for infant < 12 months; < 50 mm Hg for child >= 12 months) |
|
|
heart rate (< 50 beats per minute for infant < 12 months; < 40 beats per minute for child >= 12 months) |
|
|
cardiac arrest |
|
|
continuous vasoactive drug infusion for hemodynamic support |
|
respiratory |
respiratory rate (> 90 per minute for infant < 12 months; > 70 per minute for child >= 12 months) |
|
|
PaO2 < 40 mm Hg in absence of cyanotic heart disease |
|
|
PaCO2 > 65 mm Hg |
|
|
mechanical ventilation (> 24 hour if post-operative) |
|
|
PaO2/FIO2 ratio < 250 mm Hg |
|
|
tracheal intubation for airway obstruction |
|
|
tracheal intubation for acute respiratory failure |
|
neurologic |
Glasgow coma score < 5 |
|
|
fixed, dilated pupils |
|
|
persistent (> 20 minutes) intracranial pressure > 20 mm Hg |
|
|
persistent (> 20 minutes) intracranial pressure requiring therapeutic intervention |
|
hematologic |
hemoglobin < 5 g/dL |
|
|
WBC count < 3,000 per µL |
|
|
platelet count < 20,000 per µL |
|
|
DIC (prolonged PT and PTT, fibrin degradation products) |
|
renal |
BUN > 100 mg/dL |
|
|
serum creatinine > 2 mg/dL |
|
|
dialysis |
|
gastrointestinal |
blood transfusion > 20 mL per kg in 24 hours because of GI hemorrhage |
|
hepatic |
total bilirubin > 5 mg/dL AND SGOT or LDH > 2 times upper limit of normal AND hemolysis absent |
|
|
hepatic encephalopathy >= Grade II |
number of organ system failures =
= (number of systems showing evidence of failure)
Interpretation:
• minimum number: 0
• maximum number: 7
• The higher the number of organ system failures, the greater the risk of mortality.
|
Number of Organ System Failures |
Mortality Rate in Percent (in 1987) |
|
2 |
25% |
|
3 |
60% |
|
4 |
86% |
from Figure 2, page 327
Specialty: Critical Care, Emergency Medicine, Pedatrics
