Epidemiology and outcomes of multiple organ dysfunction syndrome following pediatric trauma

Abstract

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 pediatric intensive care unit (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 database from 2009 to 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 postoperative status. RESULTS: Multiple organ dysfunction syndrome 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. Pediatric intensive care unit mortality was 20.1% among patients with MODS versus 0.5% among patients without MODS (adjusted relative risk, 32.3; 95% confidence interval, 24.1-43.4). Mortality ranged from 1.5% for one dysfunctional organ system to 69.1% for four or more 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 versus 8.3% of patients without MODS (adjusted relative risk, 4.3; 95% confidence interval 3.4-5.3). CONCLUSION:Multiple organ dysfunction syndrome 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.

Comprehensive Assessment of Mid-Regional Proadrenomedullin, Procalcitonin, Neuron-Specific Enolase and Protein S100 for Predicting Pediatric Severe Trauma Outcomes

“…The mortality risk in children with severe injury is closely linked to the development of multiple organ failure (MOF). The rate of post-injury MOF in children treated in an intensive care unit (ICU) ranges from 11.3% to 23.1%, with a mortality rate of 20.1% to 53% among injured children with MOF, compared to only 0.5% among those without MOF [ 2 , 3 ]. MOF can develop rapidly in children, with 75–86% of cases occurring within the first 24 h in the ICU [ 4 ].…”

Dynamics of T helper subpopulations in the critical period of severe injury in children

“…Severe mechanical injury is one of the main reasons behind children's disability and mortality [3]. Severe injury induces a complex host immune response to tissue injury, a parallel pro-and anti-inflammatory state, bearing an elevated risk for infectious complications (IC) and/or multiple organ failure (MOF) [1,5].…”

T helper subsets during the acute post-traumatic period in children

“…Severe mechanical injury is one of the leading causes of childhood disability and mortality [4]. Severe injury induces a complex host immune response to tissue damage, a parallel pro-and antiinflammatory state associated with an increased risk of infectious complications (IC) and/or multiple organ failure (MOF) [2,6].…”