Epidemiology and Outcomes of Multiple Organ Dysfunction Syndrome Following Pediatric Trauma
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Shock Non Sepsis, Worldwide Data, Pediatrics, 2022
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INTRODUCTION: While multiple organ dysfunction syndrome (MODS) is common among general PICU populations, existing studies have found a low incidence of MODS in pediatric trauma patients, typically by applying adult criteria to single-center pediatric cohorts. We used pediatric criteria to determine the incidence and outcomes of MODS among critically injured children in a national PICU database.
METHODS: We conducted a retrospective cohort study of PICU patients < 18 years with traumatic injury in the Virtual Pediatric Systems (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 [POPC/PCPC] ≥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 region and mechanism, and post-operative status.
RESULTS: MODS was present on Day 1 of PICU admission in 23.1% of 37,332 trauma patients (n=8,621). PICU mortality was 20.0% 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 69.0% for ≥4 organ systems, and was highest among patients with hematologic dysfunction (43.1%) and renal dysfunction (29.6%). Death or poor functional outcome occurred in 46.7% of MODS patients vs. 8.3% of patients without MODS (aRR 4.4, 95% CI 3.4-5.3). Among survivors, MODS was associated with an adjusted mean 5.3 additional PICU days (95% CI 5.2-5.5),.and 40.4% of MODS survivors experienced a decline in POPC/PCPC from baseline vs 9.7% of survivors without MODS (aRR 3.3, 95% CI 2.6-4.3).
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 that identified Day 1 MODS in 18.6% of general PICU patients in VPS with 10.3% mortality, both the incidence and mortality associated with MODS are higher among trauma patients than the general PICU population, suggesting the need for particular attention to MODS prevention and treatment strategies among critically injured children.
Meta Tag
Content Type Presentation
Knowledge Area Shock Non Sepsis
Knowledge Area Pediatrics
Knowledge Area Worldwide Data
Knowledge Level Advanced
Membership Level Select
Tag Multiple Organ Dysfunction
Tag Epidemiology Outcomes
Tag Pediatrics
Year 2022
multiple organ dysfunction syndrome
pediatric trauma
medical complications


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