In this video, Dr. Murray Pollack, MD, MBA, Director of Outcomes Research at Children’s National Medical Center and a Professor of Pediatrics at George Washington University School of Medicine, will review the historical perspective of severity of illness research in pediatric critical care medicine and outline a framework for evaluating outcomes research.
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Welcome to World Shared Practices Forum. I'm Doctor Jeff Burns, Chief of Critical Care at Boston Children's Hospital and Harvard Medical School. We're very pleased to have with us today Doctor Murray Pollack. Dr. Pollack is the Director of Outcomes Research at the Children's National Medical Center and Professor of Pediatrics at the George Washington University School of Medicine-- all in Washington, DC.
Thank you, Jeff. It's a a pleasure to be here at I'm very pleased with this opportunity.
Dr. Pollack, welcome. In 1988, you published what is clearly one of the landmark papers in our field. You published in that year the pediatric risk of mortality score-- PRISM. In that time, across the world, it's now really the preeminent score to assess the risk of mortality. That, and the so-called PIM score-- the pediatric index of mortality-- are the two scores that our colleagues around the world rely on to really assess their performance and benchmark against others. Could you take us back to the early days of that, and the severity of illness concept, and then building from that, outcomes research and what led you to the PRISM score?
Severity of illness research probably started with Virginia Apgar, at least in the modern era. She was the first person to quantify physiologic status for patients-- in this case, it was newborns. The second group that used severity of illness for quantifying physiologic status was, of course, Jennett and Teasdale, when they developed the Glasgow Coma Scale score. That was remarkable because that score had so much content validity that it was actually used before it's full validation had been published. It became a worldwide standard, even without statistical validation.
And finally, getting to the modern era, I give credit to Bill Knaus at George Washington University for developing the modern day approach to severity of illness assessment. And Bill, as you know, was the originator of the APACHE score, or acute physiology and chronic health evaluation. What Bill did was take off on the concept that had been around for maybe 10 or 15 years that the number of organ systems that had failed was directly related to mortality risk. And this slide, which is redrawn from some of our pediatric data from 1980s clearly indicates that the more organs that have failed, the higher the mortality risk. A failed organ system is diagnosed by physiologic dysfunction.
