Graciano et al reported the Pediatric Multiple Organ Dysfunction Score (P-MODS) for evaluating a critically ill pediatric patient. This can help to identify a patient who may benefit from more aggressive management. The authors are from Children's Hospital of Central California, University of California at San Francisco-Fresno, Eclipsys Corporation, Children's Medical Center of Dallas and DARPA Defense Sciences Office.
Patient selection: pediatric pateint, excluding repair of congenital heart disease
Outcome: mortality during time in the ICU
Parameters, based on worst score during ICU stay:
(1) lactic acid in mmol/L (cardiovascular)
(2) PaO2 to FIO2 ratio (respiratory)
(3) total serum bilirubin in mg/dL (hepatic)
(4) fibrinogen in mg/dL (hematologic)
(5) BUN in mg/dL (renal)
|
Parameter
|
Finding
|
Points
|
|
lactic acid
|
< 1 mmol/L
|
0
|
|
|
1.0 to 1.99 mmol/L
|
1
|
|
|
2.0 to 4.99 mmol/L
|
2
|
|
|
5.0 to 7.5 mmol/L
|
3
|
|
|
> 7.5 mmol/L
|
4
|
|
PaO2 to FIO2 ratio
|
> 150
|
0
|
|
|
100 to 150
|
1
|
|
|
75 to 99.99
|
2
|
|
|
50 to 74.99
|
3
|
|
|
< 50
|
4
|
|
total serum bilirubin
|
< 0.5 mg/dL
|
0
|
|
|
0.5 to 1.99 mg/dL
|
1
|
|
|
2.0 to 4.99 mg/dL
|
2
|
|
|
5.0 to 10 mg/dL
|
3
|
|
|
> 10 mg/dL
|
4
|
|
fibrinogen
|
> 150 mg/dL
|
0
|
|
|
125 to 150 mg/dL
|
1
|
|
|
100 to 124.9 mg/dL
|
2
|
|
|
75 to 99.9 mg/dL
|
3
|
|
|
< 75 mg/dL
|
4
|
|
BUN
|
< 20 mg/dL
|
0
|
|
|
20 to 39.9 mg/dL
|
1
|
|
|
40 to 59.8 mg/dL
|
2
|
|
|
60 to 80 m/dL
|
3
|
|
|
> 80 mg/dL
|
4
|
where:
• Several ranges overlapped at the breakpoints. These were made discrete above.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
• The higher the score the greater the risk of mortality.
|
Score
|
Mortality in ICU
|
|
0
|
2-3%
|
|
1 to 4
|
7%
|
|
5 to 8
|
17%
|
|
9 to 12
|
33 to 47%
|
|
13 to 16
|
56 to 67%
|
|
17 to 20
|
71 to 85%
|
from Figure 6
Performance:
• The area under the ROC curve was 0.78 (validation set) and 0.81 (derivation set).
