External validation of the paediatric logistic organ dysfunction score

• Published in: Intensive care medicine Vol. 36; no. 1; pp. 116 - 122
• Main Authors: Garcia, Pedro Celiny R., Eulmesekian, Pablo, Branco, Ricardo G., Perez, Augusto, Sffogia, Ana, Olivero, Lorenzo, Piva, Jefferson P., Tasker, Robert C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 2010; Springer; Springer Nature B.V
• Subjects: Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Argentina; Argentina - epidemiology; Biological and medical sciences; Brazil; Calibration; Catchment Area (Health); Chi-square test; Child; Child, Preschool; Clinical trials; Critical Care Medicine; Data collection; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency Medicine; Female; Health aspects; Humans; Infant; Infant, Newborn; Intensive; Intensive care; Intensive care medicine; Intensive Care Units, Pediatric - statistics & numerical data; Length of Stay - statistics & numerical data; Male; Medical sciences; Medicine; Medicine & Public Health; Mortality; Multiple organ dysfunction syndrome; Multiple Organ Failure - diagnosis; Multiple Organ Failure - mortality; Multiple Organ Failure - physiopathology; Normal distribution; Pain Medicine; Patient Admission - statistics & numerical data; Pediatric intensive care; Pediatric Original; Pediatrics; Pneumology/Respiratory System; Premature babies; Reproducibility of Results; ROC Curve; Severity of Illness Index; South America; Surveys and Questionnaires; Taiwan; Treatment Outcome; Variables; Ventilators; Vital signs; Argentina; South America; Brazil; Taiwan; Validation; Intensive care; Organ dysfunction; Children; PELOD; Mortality; Human; Morality; Child; Resuscitation; Logistics
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-009-1489-1

Objective External validation of the paediatric logistic organ dysfunction (PELOD) score in two paediatric intensive care units (PICU) in South America. Methods Prospective observational cohort study including all PICU admissions from July 2003 to December 2004 in Porto Alegre, Brazil, and from January 2004 to December 2004 in Buenos Aires, Argentina. The data collected included demographic variables, diagnosis, need for mechanical ventilation, length of PICU stay and mortality, and the 12 variables in the PELOD score. For each PELOD score variable, the worst daily value and the worst value of the whole PICU stay were used for the daily PELOD (dPELOD) and PELOD scores, respectively. Results A total of 1,476 admissions (51.3% from Argentina and 48.7% from Brazil) were analysed. Observed and predicted mortality were, respectively, 4.7% and 6.6%, with a standardized mortality ratio of 0.72. The score showed excellent discrimination capacity, with an area under the receiver operator characteristic (ROC) curve of 0.93 (0.88–0.98). The dPELOD score on days 1–5 also showed good discrimination capacities, with areas under the ROC curve >0.85. However, PELOD and dPELOD scores showed poor calibration with the Hosmer–Lemeshow test (chi-square 72.3, p  < 0.001). This poor calibration was explained by a deficiency in the PELOD score where it fails to identify two risk intervals; 3.1–16.2% and 40–80%. Conclusions The PELOD score is reproducible, has excellent discrimination, but over-predicts mortality and has poor calibration. Although the lack of calibration may not invalidate the score, the PELOD score is a discontinuous variable and we advise careful consideration when using it as a surrogate endpoint in clinical trials.