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

Ana Lia Graciano, James A. Balko, Donna S. Rahn, Naveed Ahmad, Brett P. Giroir

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

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 O 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.

Original languageEnglish (US)
Pages (from-to)1484-1491
Number of pages8
JournalCritical Care Medicine
Volume33
Issue number7
DOIs
StatePublished - Jul 2005

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Organ Dysfunction Scores
Pediatric Intensive Care Units
Critical Illness
Pediatrics
Mortality
Pediatric Hospitals
Validation Studies
Blood Urea Nitrogen
Computer Systems
Tertiary Healthcare
Cardiovascular System
Bilirubin
ROC Curve
Teaching Hospitals
Fibrinogen
Area Under Curve
Observational Studies
Survivors
Lactic Acid
Cohort Studies

Keywords

  • Critical illness
  • Intensive care unit
  • Multiple organ failure
  • Outcome measure
  • Pediatrics
  • Severity of illness index

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

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. / Graciano, Ana Lia; Balko, James A.; Rahn, Donna S.; Ahmad, Naveed; Giroir, Brett P.

In: Critical Care Medicine, Vol. 33, No. 7, 07.2005, p. 1484-1491.

Research output: Contribution to journalArticle

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title = "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",
abstract = "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 O 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.",
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AU - Rahn, Donna S.

AU - Ahmad, Naveed

AU - Giroir, Brett P.

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N2 - 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 O 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.

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KW - Outcome measure

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