Pediatric Organ Dysfunction Information Update Mandate (PODIUM) Contemporary Organ Dysfunction Criteria: Executive Summary

Abstract

Prior criteria for organ dysfunction in critically ill children were based mainly on expert opinion. We convened the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) expert panel to summarize data characterizing single and multiple organ dysfunction and to derive contemporary criteria for pediatric organ dysfunction. The panel was composed of 88 members representing 47 institutions and 7 countries. We conducted systematic reviews of the literature to derive evidence-based criteria for single organ dysfunction for neurologic, cardiovascular, respiratory, gastrointestinal, acute liver, renal, hematologic, coagulation, endocrine, endothelial, and immune system dysfunction. We searched PubMed and Embase from January 1992 to January 2020. Study identification was accomplished using a combination of medical subject headings terms and keywords related to concepts of pediatric organ dysfunction. Electronic searches were performed by medical librarians. Studies were eligible for inclusion if the authors reported original data collected in critically ill children; evaluated performance characteristics of scoring tools or clinical assessments for organ dysfunction; and assessed a patient-centered, clinically meaningful outcome. Data were abstracted from each included study into an electronic data extraction form. Risk of bias was assessed using the Quality in Prognosis Studies tool. Consensus was achieved for a final set of 43 criteria for pediatric organ dysfunction through iterative voting and discussion. Although the PODIUM criteria for organ dysfunction were limited by available evidence and will require validation, they provide a contemporary foundation for researchers to identify and study single and multiple organ dysfunction in critically ill children.

Clinical application of regional citrate anticoagulation for continuous renal replacement therapy in children with liver injury

“…Or, children without the underlying chronic liver disease have acute liver injury accompanied by multiple organ systems malfunction, with or without encephalopathy caused by hepatocyte necrosis. LD was defined as those who met the PODIUM criteria ( 15 , 16 ) for LD but did not meet the diagnostic criteria for LF, including: aspartate aminotransferase (AST) >100 IU/L or alanine aminotransferase (ALT) >100 IU/L or glutamyl transpeptidase (GGT) >100 IU/L or total bilirubin (TB) >5 mg/dl (>85.5 μmol/L) or direct or conjugated bilirubin (DB) >2 mg/dl (>34.2 μmol/L). This study has been reviewed and approved by the Ethics Committee of the Children's Hospital of Chongqing Medical University, with ethical review number: (2020) NLS (Y) No.…”

Multiple Organ Dysfunction Interactions in Critically Ill Children

“…We considered nine different organ dysfunctions in all patients per the PODIUM consensus criteria (cardiovascular, coagulation, respiratory, neurologic, renal, hematologic, immunologic, liver, and endocrinologic). The methods used to calculate these organ dysfunctions from EHR data have been previously published ( 11 ). Missing values were assumed to be within the normal range, and therefore negative for organ dysfunction.…”

“…Various diagnostic criteria for pediatric organ dysfunction have been developed, validated, and applied clinically, including those by Wilkinson, Proulx, and the International Pediatric Sepsis Consensus Conference (IPSCC) ( 8 – 10 ). Recently, the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) investigators developed novel consensus criteria for single and MOD based on systematic literature reviews ( 11 ). These criteria were validated using electronic health record (EHR) data and they showed improved performance in discriminating mortality compared to the widely used IPSCC criteria for organ dysfunction ( 12 ).…”

The use of machine learning and artificial intelligence within pediatric critical care

“…The pediatric organ dysfunction information update mandate (PODIUM) developed contemporary criteria to define pediatric single-and multi-organ dysfunction. 51 The panel of 88 content experts from 47 institutions appraised the body of present-day peer-reviewed evidence defining pediatric organ failure for 11 organ systems. The goals of this endeavor are to promote early recognition and appropriate treatment of pediatric organ dysfunction to create a globally accepted platform for universal nomenclature, promoting enhanced multiinstitutional collaborative research.…”