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OUTCOME OF CHILDREN WITH MULTIPLE SYSTEM ORGAN FAILURE

Multiple system organ failure (OSF) in infants and children has not been studied. We hypothesized that (1) severity of illness (mortality) is associated with increasing number of OSFs and (2) the mortality associated with multiple OSF in pediatric patients would differ significantly from adult results. Methods: Physiologic data (pertaining to the C-V, respiratory, neurologic, hematologic, and renal systems) in 831 consecutive admissions to a pediatric ICU were analyzed daily. Criteria for OSF were rigidly defined (e.g. renal failure = BUN > 100, creatinine > 2, dialysis). Results: 467 (56%) of patients had 1 or more OSFs. Mortality increased directly with increasing number of OSFs (p < .0001) as follows: 1 OSF (n = 241) = 1% mortality; 2 OSFs (n = 142) = 11% mortality; 3 OSFs (n = 72) = 50% mortality; 4 OSFs (n = 12) = 75% mortality. There were no significant differences in mortality among specific OSFs or combination of OSFs. For the first 10 days of OSF, mortality was not associated with duration of OSF. The independece of mortality and duration of OSF is significantly different from published adult results (p <.005). Discussion: Mortality is significantly associated with increasing numbers of OSFs but not the duration of OSF or specific OSF combinations. The mortality for multiple OSF in pediatric patients is significantly less than in adults. Results of studies in adults ICU patients do not necessarily apply to pediatric patients.