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Les scores de gravité généraux et de dysfonctions d’organes en réanimation pédiatrique : quoi de neuf en 2016 ?

Severity of illness and organ dysfunction scoring in pediatric intensive care unit: What news in 2016?

  • Mise au Point / Update
  • Published:
Médecine Intensive Réanimation

Résumé

Les scores de gravité généraux et de dysfonctions d’organes (DO) sont de plus en plus utilisés dans les services de réanimation adultes et pédiatriques. Cette utilisation est justifiée par la nécessaire évaluation objective de la gravité et du niveau des DO des patients durant le séjour en réanimation. En réanimation pédiatrique, les scores de gravité généraux sont établis, indépendamment du diagnostic, en prenant en compte l’hétérogénéité des populations en termes d’âge notamment. Ces scores permettent d’évaluer la gravité dans les premières heures après l’admission en réanimation. Deux « systèmes » de scores de gravité généraux pédiatriques ont été proposés pour la population allant du nouveau-né (prématurés exclus) à l’adolescent : le système Pediatric Index of Mortality (PIM), le PIM3 étant la dernière version établie en 2013 et le système Pediatric Risk of Mortality (PRISM), le PRISM IV, dont la dernière version date de 2016. Les scores de DO, prenant en compte des paramètres physiologiques reflétant les principales DO, ont été développés et validés pour décrire les DO durant le séjour en réanimation. Le système de score de DO pédiatrique le plus utilisé est le Pediatric Logistic Organ Dysfunction (PELOD), dont la dernière version (PELOD-2) date de 2013. L’objectif de cette revue est : 1) de donner un état des lieux actualisé des scores de gravité généraux et des DO en réanimation pédiatrique ; 2) d’expliciter les moyens de mesure de la performance et de l’adaptation des scores ; 3) de donner l’utilité, les limites et les perspectives des scores en réanimation pédiatrique.

Abstract

Severity of illness and organ dysfunction scoring systems are increasingly used in adult and pediatric intensive care unit (PICU) to characterize disease severity and degree of organ dysfunction. In PICU, severity of illness scores are developed independently of diagnosis, taking into account the age of the different populations. Severity of illness scores were developed to better describe the severity of illness at baseline of groups of critically ill patients. Two systems are available: the pediatric index of mortality (PIM)—latest version PIM3 published in 2013, and the Pediatric RISk of Mortality (PRISM) system, which should be used in critically ill neonates, infants, children, or adolescents, (excluding premature infants)—latest version PRISM IV published in 2016. Organ dysfunction scores were developed to better describe the severity of illness during stay in the PICU. The Pediatric Logistic Organ Dysfunction score is the most commonly used pediatric organ dysfunction score—latest version PELOD-2 published in 2013. The purpose of this review is to provide an update about severity of illness and organ dysfunction scoring systems in PICU, to describe tools to evaluate performance and customization, and then discuss utility, limits and perspectives for scoring systems in PICU.

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Authors and Affiliations

  1. service de réanimation pédiatrique, CHU Lille, F-59000, Lille, France

    S. Leteurtre, M.-E. Lampin & M. Recher

  2. Univ. Lille, EA 2694, Santé publique : épidémiologie et qualité des soins, université de Lille, F-59000, Lille, France

    S. Leteurtre, M.-E. Lampin, B. Grandbastien & A. Duhamel

  3. Unité de lutte contre les infections nosocomiales, service du risque infectieux, des vigilances et d’infectiologie, CHU Lille, F-59000, Lille, France

    B. Grandbastien

  4. Service de biostatistiques, CHU Lille, F-59000, Lille, France

    A. Duhamel

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  1. S. Leteurtre
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Correspondence to S. Leteurtre.

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Leteurtre, S., Lampin, ME., Grandbastien, B. et al. Les scores de gravité généraux et de dysfonctions d’organes en réanimation pédiatrique : quoi de neuf en 2016 ?. Méd. Intensive Réa 25, 604–618 (2016). https://doi.org/10.1007/s13546-016-1220-5

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