Development of a Multi-State Pediatric Outcome Model

We will develop a multi-level risk estimation of outcome states from pediatric intensive careincorporating poor functional/adaptive survival state(s) as well as death. This severity of illness methodwill be an important advance over survival/death predictors and will enhance quantitative qualityassurance studies, risk adjustment, cost evaluations, and individuals' decision-making. This study willinvolve pediatric ICU to estimate the multi-state outcome predictor using poly-logistic regression analysis.Predictor variables will include physiologic variables, pre-admission location, operative status, principlediagnosis categorizations, disease stage, age, computed tomography (CT) severity classification andbaseline functional status. Survival categories will be determined using the Vineland Adaptive BehaviorScale (VABS). The Phase I primary aim is to develop a scale and evaluate quicker and more convenientmeasures of functional status than the VABS. Such a simplified tool will facilitate performance of thePhase II study and the acceptance of the resulting model. The appropriate indications and/or screeningtests will be chosen by pediatricians, intensivists, and developmentalist. Statistical comparison will bedone to evaluate inter-rater reliability and consistency. Phase I will also develop a manual for thecollectors of this information in Phase II, and design Phase II, including the statistical methodology.