The epidemiology of MODS (incidence, prevalence, mortality) must be more clearly delineated. Current definitions and diagnostic criteria are useful, but newer case definitions must be developed that are objective, uniformly accepted and applied, developmentally adjusted, and evidence based. The assessment of the reliability and the reproducibility of such a new set of diagnostic criteria will be important. The incorporation of a contemporary definition of MODS and acute organ dysfunctions into the International Classifications of Diseases may facilitate large-scale epidemiological studies. The effect of the severity, the constellation of specific dysfunctional organs, and the treatment of MODS on outcomes is just beginning to be elucidated. Further research into these associations may result in more effective therapies and prognostication. The long-term outcomes of MODS including late mortality; health-related quality of life parameters including physical, psychological, and cognitive function; the impact of MODS on the family such as parental relationships and sibling well-being; and the economic effects of this syndrome need to be established. At this point, data are lacking. Research into these longitudinal issues will be difficult and complex, as follow up is challenging; however, such effort appears warranted. A better understanding of the value that patients and families place on different outcomes remains to be established. Specifically, the medical costs, resource use, post-discharge costs, and family financial impact of MODS are poorly understood. Research is needed to explore virtually every aspect of the outcomes and family experience surrounding MODS. Optimizing outcomes for critically ill children requires a better understanding of the complex factors that contribute to psychiatric morbidity within the child’s family system including the impact of the subjective experience. The implications of socioeconomic status, cultural and religious factors, and nontraditional family units (including single parent caregivers) for post-discharge outcome following pediatric critical illness have yet to be investigated.(103)
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