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Severity of illness and organ dysfunction scoring in children

Lacroix, Jacques MD, FRCPC, FAAP; Cotting, Jacques MD

Pediatric Critical Care Medicine: May 2005 - Volume 6 - Issue 3 - p S126-S134
doi: 10.1097/01.PCC.0000161287.61028.D4
The Study of Pediatric Sepsis

Objective: To describe predictive and descriptive general scores that can be used to estimate the severity of illness in critically ill children.

Design: Review of the medical literature.

Setting: Pediatric intensive care units (PICUs).

Patients: Critically ill children.

Interventions: None.

Measurements and Main Results: Two predictive scores are frequently used in PICUs: the Pediatric Risk of Mortality III score and the Pediatric Index of Mortality 2. The data considered in these scores are collected at baseline. Predictive scores can be used to compare expected and observed mortality in PICUs or to estimate the balance in the baseline severity of illness of patients included in the different arms of a randomized clinical trial. Only one descriptive score is validated to estimate the severity of cases of multiple organ dysfunction syndrome in PICUs, namely, the Pediatric Logistic Organ Dysfunction score. The data required to calculate this score are collected from baseline to discharge from the PICU or up to 2 hrs before death in the PICU. The Pediatric Logistic Organ Dysfunction score can be used to describe the clinical outcome of patients during their stay in a PICU.

Conclusion: Pediatric Risk of Mortality III, Pediatric Index of Mortality 2, and Pediatric Logistic Organ Dysfunction scores are the best available tools to estimate the severity of illness in critically ill children.

From the Division of Pediatric Critical Care, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, Canada (JL); and the Pediatric Intensive Care Unit, University Hospital of Lausanne, Switzerland (JC).

Presented, in part, at the International Sepsis Forum on Sepsis in Infants and Children, Boston, MA, September 23–26, 2004.

Address requests for reprints to: Jacques Lacroix, MD, FRCPC, FAAP, Sainte-Justine Hospital, 3175 Côte Sainte-Catherine, Montreal, Quebec, Canada H3T 1C5. E-mail:

This work was supported by the Mannion Family Fund—Center for the Critically Ill Child, Division of Critical Care Medicine at Children's Hospital Boston, the PALISI Network, and the ISF.

©2005The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies