Modified pediatric logistic organ dysfunction scoring system: A feasible tool in pediatric intensive care units

Background Pediatric logistic organ dysfunction (PELOD) score, which can predict mortality or multiple organ dysfunction syndrome (MODS) outcomes, has been validated for children. It is cumbersome to measure respiratory dysfunction variables included in original PELOD scoring, in ventilator and blood gas analysis limited setups, so all three variables included under respiratory dysfunction (i.e. PaO2/FiO2 ratio, PaCo2 and mechanical ventilation) in original PELOD score were replaced by three new variables (i.e., respiratory rate, chest retractions and SpO2). The present study aims to modify the PELOD score and make it more clinical and feasible to adopt in resource-limited setups rather being dependent on sophisticated facilities. Aims Evaluation of modified PELOD scoring system to determine the prognosis of patients in pediatric intensive care units (PICU). Material and Method The modified PELOD scoring system consists of physical and laboratory variables representing six organ systems namely neurological, cardiovascular, renal, respiratory, hematological, and hepatic system. The score was calculated for the subjects during first 24 h of admission in PICU. Patients were then followed until they were discharged from PICU or deceased. In each organ system, the highest score in any variable accounted was taken as the score for that organ system. The sum total of the 6 scores for each organ system gives modified PELOD score (range 0-71) which was used for looking at the association between modified PELOD score and mortality. Results The risk of mortality varies directly with the modified PELOD score of the patients. In those patients whose modified PELOD score was <10, mortality was 10.4%, whereas in patients whose modified PELOD score was >10, mortality increased significantly to 46.4% (χ2 = 12.000, P < 0.001). The mean (SD) modified PELOD score was considerably higher in those who died as compared to those who survived (16.25 [8.63] vs. 7.68 [5.55]; P < 0.001). Conclusion The modified PELOD score can be used as a reliable prognostic predictor of mortality among PICU patients.