Epidemiology and Outcomes of Pediatric Multiple Organ Dysfunction Syndrome

Abstract

Objective: To summarize the epidemiology and outcomes of children with multiple organ dysfunction syndrome as part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development multiple organ dysfunction syndrome workshop (March 26-27, 2015).

Data sources: Literature review, research data, and expert opinion.

Study selection: Not applicable.

Data extraction: Moderated by an experienced expert from the field, issues relevant to the epidemiology and outcomes of children with multiple organ dysfunction syndrome were presented, discussed, and debated with a focus on identifying knowledge gaps and research priorities.

Data synthesis: Summary of presentations and discussion supported and supplemented by the relevant literature.

Conclusions: A full understanding the epidemiology and outcome of multiple organ dysfunction syndrome in children is limited by inconsistent definitions and populations studied. Nonetheless, pediatric multiple organ dysfunction syndrome is common among PICU patients, occurring in up to 57% depending on the population studied; sepsis remains its leading cause. Pediatric multiple organ dysfunction syndrome leads to considerable short-term morbidity and mortality. Long-term outcomes of multiple organ dysfunction syndrome in children have not been well studied; however, studies of adults and children with other critical illnesses suggest that the risk of long-term adverse sequelae is high. Characterization of the long-term outcomes of pediatric multiple organ dysfunction syndrome is crucial to identify opportunities for improved treatment and recovery strategies that will improve the quality of life of critically ill children and their families. The workshop identified important knowledge gaps and research priorities intended to promote the development of standard definitions and the identification of modifiable factors related to its occurrence and outcome.

Figure 1. The importance of timing in the determination of incident and prevalent cases of multiple organ dysfunction syndrome (MODS)

The timing of the study of MODS during the course of hospitalization is crucial to the accurate determination of its incidence and prevalence. If MODS is assessed continuously over time, then all new cases will be identified. However, if MODS is only assessed at a single time point, then MODS that results in death prior to that single time point (early death) will be missed. Similarly, MODS that resolves prior to the single time point assessment will also be missed.

Figure 2. Mortality after multiple organ dysfunction syndrome (MODS) reported in individual studies

Each point in the graph represents the MODS-associated mortality reported in an individual study. Mortality varies markedly according to study size, inclusion criteria, and the therapeutic modality evaluated.(, , , , , –, , , –109)

Figure 3. Influences on health-related quality of life (HRQL) after pediatric critical illness

HRQL is affected by multiple factors, including individual psychological, biological, and environmental characteristics. In pediatric critical illness, additional factors are influential including the background capacity for growth and development, characteristics of the health care system, the illness or insult leading to critical illness, and the course of the illness (including both its natural history, response to therapy, and insults related to ICU care). These relationships are multi-directional. For example, a child’s HRQL can affect chronic illness status, individual psychological health, and the family of the child, which can in turn, affect the risk of subsequent episodes of critical illness. Modified from Wilson and Cleary, 1995.(57)