A global group of acute pediatric critical illness experts, in collaboration with St. Jude Children’s Research Hospital investigators, have reached a consensus definition for acute pediatric critical illness. The need for a universally applicable definition arose from the challenge of improving care in low- and middle-income countries where traditional pediatric critical illness definitions are not suitable.
The newly established definition, achieved through consensus among researchers and clinicians from 40 countries, will facilitate the study of pediatric critical illness across diverse settings. This is expected to result in improved patient outcomes worldwide. The complete definition has been published in The Lancet Global Health.
Dr. Anita Arias, the first and corresponding author from St. Jude Department of Pediatric Medicine, emphasized the significance of having a common language for acute pediatric critical illness. This shared understanding will enhance data collection at a global scale and enable larger patient sample sizes, leading to more robust clinical studies and evidence-based interventions.
The new definition states that acute pediatric critical illness is characterized by an illness, injury, or post-operative state that increases the risk of acute physiological instability or clinical support requirements to prevent further deterioration or death. These physiological instability, support requirements, or both, serve as criteria for meeting the definition.
Dr. Arias, along with Dr. Asya Agulnik, St. Jude Global Critical Care director, led a team of international researchers and clinicians specializing in acute pediatric critical illness to develop the definition. A total of 109 experts from 40 countries participated in the process, utilizing a method called modified Delphi, which ensured anonymity and encouraged open voting and expression of opinions on draft statements. The final definition represents a consensus reached by these experts and was designed to be inclusive of hospitals with varying resources.
Historically, acute pediatric critical illness has been subjected to numerous definitions. Studies conducted in high-income countries often employ definitions that include technical or resource-based criteria, such as admission to an Intensive Care Unit (ICU). However, this criterion is not applicable to resource-limited healthcare settings in other countries that lack ICUs.
Dr. Arias explained that the new framework aims for inclusivity, as many hospitals worldwide do not have ICUs. Previous definitions excluded a significant portion of patients from research due to this criterion.
Dr. Agulnik highlighted the research disparity that has focused on acute pediatric critical illness in hospitals with high resources, despite the majority of childhood mortality occurring in low- and middle-income countries. By enabling the classification of critically ill patients regardless of critical care resources, the new definition aims to rectify this disparity and facilitate research in hospitals with varying resource levels.
The focus on ICUs reveals a larger issue – previous definitions excluded patients experiencing acute critical illness without access to critical care resources. To be more inclusive, the international group realized the need to define the condition based on the patient’s status rather than the specific department of admission or intervention use.
Dr. Arias provided an example to illustrate the necessity for a new definition. Traditional studies on respiratory failure typically include patients on mechanical ventilation. However, the absence of mechanical ventilation in a hospital does not imply that the patient does not have acute respiratory illness or failure.
The new definition addresses this need by focusing on the patient’s status, regardless of local resources. It considers two states: the patient’s bodily system status and the need for clinical support, such as a ventilator, without specifying the specific materials used.
The framework also includes eight attributes and 28 statements to enhance clarity and explain the definition’s application. Collectively, this framework is known as DEFinition for acute pediatric CRITical illness (DEFCRIT).
The lack of a standardized and inclusive definition for acute pediatric critical illness, particularly in low- and middle-income countries, has hindered progress in critical care. This has made it challenging to measure the total burden of critical illness and adapt methods to these settings. DEFCRIT is expected to promote a better understanding of the disease burden and enable standardized and inclusive comparisons of populations and interventions.
Dr. Arias stated that DEFCRIT has begun to bridge the gap for researchers and clinicians in understanding the global burden of critical illness. This could ultimately lead to improved care delivery by determining the effectiveness of interventions in different populations, environments, and illness stages.
DEFCRIT has already been accepted by various global groups of pediatric disease researchers. The paper lists the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network on Behalf of the PALISI Global Health Subgroup as a co-author, along with endorsements from the World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS) and the Society of Critical Care Medicine (SCCM).
Dr. Arias highlighted the group’s desire to address research disparities globally and expressed optimism that DEFCRIT will eliminate barriers to progress in research. This will enable the field to enhance global patient care through improved research endeavors.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it