1 - A Research Definition and Framework for Acute Pediatric Critical Illness Across Resource Variable Settings: A modified Delphi consensus

Using existing definitions and relevant themes that emerged from an English language scoping literature review of pediatric critical illness, an interdisciplinary, international focus group (n=24) identified the foundational domains and subdomains that comprised the framework. Next, a two-round, modified Delphi was conducted with an international multidisciplinary expert panel (n=109) via electronically distributed surveys to reach consensus, and the results were framed into the definition for acute pediatric critical illness.

Results: A total of 1,989 abstracts were screened, and 29 studies qualified for analysis. The focus group identified two domains (1. Physiologic instability and 2. Support requirement) with two subdomains each (1A. abnormal physiological parameters; 1B. vital organ impairment; 2C. need for frequent monitoring; 2D. time-sensitive interventions) to be included in DEFCRIT (Fig. 1). These were subjected to evaluation via expert consensus (August – November 2022), with 89% (97/109) retention rate among experts.  The final consensus definition for acute pediatric critical illness emerged from 8 attributes and 28 statements (median scores ≥ 7 in importance and ≥ 80% expert agreement; Fig. 2) as: “An illness, injury, or post-operative state that increases risk for or results in acute physiological instability (abnormal physiological parameters and/or vital organ dysfunction/failure) and/or a clinical support requirement (which includes need for frequent/continuous monitoring and/or a time-sensitive intervention).”

Conclusion(s): A consensus, evidence-informed, global definition for pediatric critical illness (DEFCRIT) was developed for use in research across resource-variable settings. Key domains included acute physiologic instability and clinical support requirements. The proposed definition will allow a unified approach for data collection and comparison of outcomes across pediatric patients of similar acuity while being agnostic of resource availability, and will allow categorization of patients according to DEFCRIT domains and subdomains.
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