Multiple organ dysfunction syndrome in critically ill children: clinical value of two lists of diagnostic criteria

Annals of Intensive Care

Table 2 Inter-test reproducibility of two sets of diagnostic criteria of MODS in 842 consecutive PICU patients

	Diagnosis of MODS or organ dysfunction in 842 patients
	Proulx, patients^a	Goldstein patients^b	Concordance^c	p value	Kappa score^c,d
MODS during PICU stay
1. MODS at PICU admission	124 (14.7 %)	249 (29.6 %)	81 %	<0.001	0.49 (0.43–0.56)
Progressive MODS^e	109 (12.9 %)	104 (12.4 %)	89 %	<0.001	0.50 (0.42–0.59)
2. New MODS	56 (6.7 %)	65 (7.7 %)	93 %	<0.001	0.50 (0.39–0.61)
MODS during PICU stay (1 + 2)	180 (21.4 %)	314 (37.3 %)	80 %	<0.001	0.56 (0.50–0.61)
Organ dysfunction during PICU stay
Respiratory	317 (37.7 %)	373 (44.3 %)	92 %	<0.001	0.85 (0.81–0.88)
Cardiovascular	125 (14.9 %)	15 (1.8 %)	86 %	<0.001	0.17 (0.09–0.25)
Haematological	93 (11.1 %)	122 (14.5 %)	90 %	<0.001	0.55 (0.46–0.63)
Neurological	150 (17.8 %)	428 (50.8 %)	67 %	<0.001	0.34 (0.30–0.39)
Gastrointestinal	13 (1.5 %)	Not applicable	–	–	–
Hepatic	65 (7.7 %)	107 (12.7 %)	93 %	<0.001	0.62 (0.54–0.71)
Renal	23 (2.7 %)	25 (3.0 %)	99 %	<0.001	0.91 (0.83–0.99)

95 % CI 95 % confidence interval
MODS multiple organ dysfunction syndrome, PICU paediatric intensive care unit
^aDiagnostic criteria of MODS advocated by Proulx in 1996 [4]
^bDiagnostic criteria of MODS advocated by Goldstein in 2005 [5, 6]
^cConcordance and kappa score estimate whether a given organ dysfunction was diagnosed twice or not diagnosed twice by the same observer in the same patients (inter-tests reproducibility), using in the same patients the two sets of diagnostic criteria of Proulx and Goldstein
^dAccording to Kramer [21], a kappa score is considered slight if <0.2, fair if between 0.2 and 0.4, moderate if between 0.4 and 0.6, substantial if between 0.6 and 0.8 and almost perfect if >0.8
^eProgressive MODS can happen only in patients with MODS at PICU admission