Division of Critical Care and Pulmonary Medicine, Department of Pediatrics, St Jude Children's Research Hospital, Memphis, TN, USA.
Division of Pediatric Critical Care, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Lancet Glob Health. 2024 Feb;12(2):e331-e340. doi: 10.1016/S2214-109X(23)00537-5. Epub 2024 Jan 5.
The true global burden of paediatric critical illness remains unknown. Studies on children with life-threatening conditions are hindered by the absence of a common definition for acute paediatric critical illness (DEFCRIT) that outlines components and attributes of critical illness and does not depend on local capacity to provide critical care. We present an evidence-informed consensus definition and framework for acute paediatric critical illness. DEFCRIT was developed following a scoping review of 29 studies and key concepts identified by an interdisciplinary, international core expert panel (n=24). A modified Delphi process was then done with a panel of multidisciplinary health-care global experts (n=109) until consensus was reached on eight essential attributes and 28 statements as the basis of DEFCRIT. Consensus was reached in two Delphi rounds with an expert retention rate of 89%. The final consensus definition for acute paediatric critical illness is: an infant, child, or adolescent with an illness, injury, or post-operative state that increases the risk for or results in acute physiological instability (abnormal physiological parameters or vital organ dysfunction or failure) or a clinical support requirement (such as frequent or continuous monitoring or time-sensitive interventions) to prevent further deterioration or death. The proposed definition and framework provide the conceptual clarity needed for a unified approach for global research across resource-variable settings. Future work will centre on validating DEFCRIT and determining high priority measures and guidelines for data collection and analysis that will promote its use in research.
儿科危重症的真实全球负担尚不清楚。由于缺乏一个明确界定急性儿科危重症（DEFCRIT）的通用定义，即概述危重症的组成部分和特征，且不依赖于当地提供危重症护理的能力，因此对有生命威胁的儿童的研究受到了阻碍。我们提出了一个基于证据的急性儿科危重症共识定义和框架。DEFCRIT 的制定是在对 29 项研究进行范围审查以及由跨学科、国际核心专家小组确定的关键概念（n=24）的基础上进行的。然后，通过一个多学科全球卫生保健专家小组（n=109）进行了修改后的 Delphi 流程，直到就八项基本属性和 28 个陈述达成共识，作为 DEFCRIT 的基础。在两轮 Delphi 中达成了共识，专家保留率为 89%。急性儿科危重症的最终共识定义为：患有疾病、损伤或术后状态的婴儿、儿童或青少年，其增加了急性生理不稳定（异常生理参数或重要器官功能障碍或衰竭）或临床支持需求（如频繁或持续监测或需要及时干预）的风险，以防止病情进一步恶化或死亡。拟议的定义和框架为在资源多变的环境中进行全球研究提供了统一方法所需的概念清晰度。未来的工作将集中于验证 DEFCRIT 并确定用于数据收集和分析的高优先级措施和指南，以促进其在研究中的使用。
