Sauthier Michaël, Landry-Hould Florence, Leteurtre Stéphane, Kawaguchi Atsushi, Emeriaud Guillaume, Jouvet Philippe
Pediatric Intensive Care Unit, Department of Pediatrics, Sainte-Justine Hospital, Montreal, QC, Canada.
Department of Pediatrics, Université de Montréal, Montreal, QC, Canada.
Pediatr Crit Care Med. 2020 Apr;21(4):e160-e169. doi: 10.1097/PCC.0000000000002235.
The Pediatric Logistic Organ Dysfunction-2 is a validated score that quantifies organ dysfunction severity and requires complex data collection that is time-consuming and subject to errors. We hypothesized that a computer algorithm that automatically collects and calculates the Pediatric Logistic Organ Dysfunction-2 (aPELOD-2) score would be valid, fast and at least as accurate as a manual approach (mPELOD-2).
Retrospective cohort study.
Single center tertiary medical and surgical pediatric critical care unit (Sainte-Justine Hospital, Montreal, Canada).
Critically ill children participating in four clinical studies between January 2013 and August 2018, a period during which mPELOD-2 data were manually collected.
None.
The aPELOD-2 was calculated for all consecutive admissions between 2013 and 2018 (n = 5,279) and had a good survival discrimination with an area under the receiver operating characteristic curve of 0.84 (95% CI, 0.81-0.88). We also collected data from four single-center studies in which mPELOD-2 was calculated (n = 796, 57% medical, 43% surgical) and compared these measurements to those of the aPELOD-2. For those patients, median age was 15 months (interquartile range, 3-73 mo), median ICU stay was 5 days (interquartile range, 3-9 d), mortality was 3.9% (n = 28). The intraclass correlation coefficient between mPELOD-2 and aPELOD-2 was 0.75 (95% CI, 0.73-0.77). The Bland-Altman showed a bias of 1.9 (95% CI, 1.7-2) and limits of agreement of -3.1 (95% CI, -3.4 to -2.8) to 6.8 (95% CI, 6.5-7.2). The highest agreement (Cohen's Kappa) of the Pediatric Logistic Organ Dysfunction-2 components was noted for lactate level (0.88), invasive ventilation (0.86), and creatinine level (0.82) and the lowest for the Glasgow Coma Scale (0.52). The proportion of patients with multiple organ dysfunction syndrome was higher for aPELOD-2 (78%) than mPELOD-2 (72%; p = 0.002). The aPELOD-2 had a better survival discrimination (area under the receiver operating characteristic curve, 0.81; 95% CI, 0.72-0.90) over mPELOD-2 (area under the receiver operating characteristic curve, 0.70; 95% CI, 0.59-0.82; p = 0.01).
We successfully created a freely available automatic algorithm to calculate the Pediatric Logistic Organ Dysfunction-2 score that is less labor intensive and has better survival discrimination than the manual calculation. Use of an automated system could greatly facilitate integration of the Pediatric Logistic Organ Dysfunction-2 score at the bedside and within clinical decision support systems.
儿童逻辑器官功能障碍评分-2（Pediatric Logistic Organ Dysfunction-2，PELOD-2）是一种经过验证的评分系统，用于量化器官功能障碍的严重程度，但其数据收集过程复杂，耗时且容易出错。我们假设一种能够自动收集和计算儿童逻辑器官功能障碍评分-2（automated Pediatric Logistic Organ Dysfunction-2，aPELOD-2）的计算机算法将是有效的、快速的，并且至少与手动计算方法（manual Pediatric Logistic Organ Dysfunction-2，mPELOD-2）一样准确。
回顾性队列研究。
单中心三级医疗和外科儿科重症监护病房（加拿大蒙特利尔圣贾斯汀医院）。
2013年1月至2018年8月期间参与四项临床研究的危重症儿童，在此期间手动收集了mPELOD-2数据。
无。
计算了2013年至2018年期间所有连续入院患者的aPELOD-2（n = 5279），其生存判别能力良好，受试者操作特征曲线下面积为0.84（95%CI，0.81 - 0.88）。我们还从四项计算了mPELOD-2的单中心研究中收集了数据（n = 796，57%为内科，43%为外科），并将这些测量结果与aPELOD-2的结果进行比较。对于这些患者，中位年龄为15个月（四分位间距，3 - 73个月），中位ICU住院时间为5天（四分位间距，3 - 9天），死亡率为3.9%（n = 28）。mPELOD-2与aPELOD-2之间的组内相关系数为0.75（95%CI，0.73 - 0.77）。Bland-Altman分析显示偏差为1.9（95%CI，1.7 - 2），一致性界限为-3.1（95%CI，-3.4至-2.8）至6.8（95%CI，6.5 - 7.2）。儿童逻辑器官功能障碍评分-2各组成部分的最高一致性（Cohen's Kappa）出现在乳酸水平（0.88）、有创通气（0.86）和肌酐水平（0.82）方面，而格拉斯哥昏迷量表的一致性最低（0.52）。aPELOD-2诊断的多器官功能障碍综合征患者比例高于mPELOD-2（78%比72%；p = 0.002）。aPELOD-2的生存判别能力优于mPELOD-2（受试者操作特征曲线下面积，0.81；95%CI，0.72 - 0.90），mPELOD-2的受试者操作特征曲线下面积为0.70（95%CI，0.59 - 0.82；p = 0.01）。
我们成功创建了一种免费的自动算法来计算儿童逻辑器官功能障碍评分-2，该算法比手动计算劳动强度更低，且生存判别能力更好。使用自动化系统可以极大地促进儿童逻辑器官功能障碍评分-2在床边和临床决策支持系统中的整合。
