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Epidemiology and Outcomes of Multiple Organ Dysfunction Syndrome following Pediatric Trauma.
Journal of Trauma and Acute Care Surgery 2022 April 2
BACKGROUND: Existing studies have found a low prevalence of multiple organ dysfunction syndrome (MODS) in pediatric trauma patients, typically applying adult criteria to single-center pediatric cohorts. We used pediatric criteria to determine the prevalence, risk factors, and outcomes of MODS among critically injured children in a national PICU database.
METHODS: We conducted a retrospective cohort study of PICU patients 1 month to 17 years with traumatic injury in the Virtual Pediatric Systems, LLC (VPS) database from 2009-2017. We used International Pediatric Sepsis Consensus Conference criteria to identify MODS on Day 1 of PICU admission and estimated the risk of mortality and poor functional outcome (Pediatric Overall/Cerebral Performance Category ≥3 with ≥1 point worsening from baseline) for MODS and for each type of organ dysfunction using generalized linear Poisson regression adjusted for age, comorbidities, injury type and mechanism, and post-operative status.
RESULTS: MODS was present on PICU Day 1 in 23.1% of 37,177 trauma patients (n = 8,592), with highest risk among patients with injuries associated with drowning, asphyxiation, and abuse. PICU mortality was 20.1% among patients with MODS vs. 0.5% among patients without MODS (adjusted RR 32.3, 95% CI 24.1-43.4). Mortality ranged from 1.5% for one dysfunctional organ system to 69.1% for ≥4 organ systems and was highest among patients with hematologic dysfunction (43.3%) or renal dysfunction (29.6%). Death or poor functional outcome occurred in 46.7% of MODS patients vs. 8.3% of patients without MODS (aRR 4.3, 95% CI 3.4-5.3).
CONCLUSIONS: MODS occurs more frequently following pediatric trauma than previously reported and is associated with high risk of morbidity and mortality. Based on existing literature using identical methodology, both the prevalence and mortality associated with MODS are higher among trauma patients than the general PICU population. Consideration of early organ dysfunction in addition to injury severity may aid prognostication following pediatric trauma.
LEVEL OF EVIDENCE: III, prognostic/epidemiological study.
METHODS: We conducted a retrospective cohort study of PICU patients 1 month to 17 years with traumatic injury in the Virtual Pediatric Systems, LLC (VPS) database from 2009-2017. We used International Pediatric Sepsis Consensus Conference criteria to identify MODS on Day 1 of PICU admission and estimated the risk of mortality and poor functional outcome (Pediatric Overall/Cerebral Performance Category ≥3 with ≥1 point worsening from baseline) for MODS and for each type of organ dysfunction using generalized linear Poisson regression adjusted for age, comorbidities, injury type and mechanism, and post-operative status.
RESULTS: MODS was present on PICU Day 1 in 23.1% of 37,177 trauma patients (n = 8,592), with highest risk among patients with injuries associated with drowning, asphyxiation, and abuse. PICU mortality was 20.1% among patients with MODS vs. 0.5% among patients without MODS (adjusted RR 32.3, 95% CI 24.1-43.4). Mortality ranged from 1.5% for one dysfunctional organ system to 69.1% for ≥4 organ systems and was highest among patients with hematologic dysfunction (43.3%) or renal dysfunction (29.6%). Death or poor functional outcome occurred in 46.7% of MODS patients vs. 8.3% of patients without MODS (aRR 4.3, 95% CI 3.4-5.3).
CONCLUSIONS: MODS occurs more frequently following pediatric trauma than previously reported and is associated with high risk of morbidity and mortality. Based on existing literature using identical methodology, both the prevalence and mortality associated with MODS are higher among trauma patients than the general PICU population. Consideration of early organ dysfunction in addition to injury severity may aid prognostication following pediatric trauma.
LEVEL OF EVIDENCE: III, prognostic/epidemiological study.
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