What is Pelod in medical terms?

PELOD: Pediatric Logistic Organ Dysfunction Score

PELOD is a validated scoring system used to assess and predict organ dysfunction and mortality risk in critically ill children admitted to pediatric intensive care units (PICUs).

Overview of PELOD

The Pediatric Logistic Organ Dysfunction (PELOD) score is a clinical tool designed to:

• Quantify the severity of multiple organ dysfunction in critically ill children
• Predict mortality risk in pediatric intensive care settings
• Serve as an outcome measure in clinical trials and research

Components and Scoring

The PELOD score evaluates dysfunction across six organ systems:

1. Neurological system

   • Glasgow Coma Scale
   • Pupillary reactions

2. Cardiovascular system

   • Heart rate
   • Systolic blood pressure

3. Renal system

   • Creatinine levels

4. Respiratory system

   • PaO2/FiO2 ratio
   • PaCO2
   • Mechanical ventilation status

5. Hematologic system

   • White blood cell count
   • Platelet count

6. Hepatic system

   • AST (aspartate aminotransferase)
   • Prothrombin time

For each organ system, the worst daily value is recorded to calculate the daily PELOD (dPELOD) score, while the worst value during the entire PICU stay determines the overall PELOD score 1.

Clinical Utility and Validation

The PELOD score has been externally validated in multiple settings, including South American PICUs, where it demonstrated:

• Excellent discrimination capacity with an area under the ROC curve of 0.93
• Good discrimination capacity for daily PELOD scores on days 1-5 (ROC >0.85)
• However, it showed poor calibration with the Hosmer-Lemeshow test, tending to over-predict mortality 1

Applications in Clinical Practice

The PELOD score is recognized as an important outcome measure for:

• Assessing internal organ dysfunction in children with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) 2
• Monitoring disease progression in critically ill pediatric patients
• Comparing severity across different patient populations
• Evaluating treatment efficacy in clinical trials

Limitations and Considerations

When using the PELOD score, clinicians should be aware of several limitations:

• It tends to over-predict mortality in some populations 1
• It is a discontinuous variable, which may affect its use as a surrogate endpoint in clinical trials
• The score may not identify certain risk intervals (3.1-16.2% and 40-80%) accurately 1
• It should be used alongside clinical judgment, not as the sole determinant for treatment decisions

Practical Implementation

For accurate PELOD scoring:

• Collect all 12 variables systematically
• Record the worst value for each parameter within the assessment period
• Calculate both daily scores (dPELOD) and the overall PELOD score for the entire PICU stay
• Use standardized methods for measuring each parameter to ensure consistency

The PELOD score remains a valuable tool for quantifying organ dysfunction severity in critically ill children, despite its calibration limitations. When properly applied, it can help guide clinical decision-making and serve as an important outcome measure in pediatric critical care research.