Pediatric Intensive Care Core Outcomes–a modified Delphi consensus process (PIC-CO)

Despite substantial improvements in survival after pediatric intensive care, long-term morbidity remains frequent and insufficiently assessed. No standardized, consensus-based core outcome set (COS) tailored to German-speaking regions exists. This study developed a Pediatric Intensive Care Core Outcome (PIC-CO) set to harmonize outcome assessment and follow-up of PICU survivors for clinical practice and research in German-speaking regions. A modified Delphi process was conducted within the Section of Pediatric Intensive Care and Emergency Medicine (SPIE) of the German Interdisciplinary Association of Intensive Care and Emergency Medicine. A multiprofessional expert panel identified outcome domains and questionnaires. Following internal consensus using predefined criteria, candidate questionnaires and short-term outcomes were submitted to an external Delphi survey distributed to SPIE members. Consensus and acceptance thresholds were defined a priori. Final questionnaire selection and recommendations for follow-up time points were agreed on by the expert panel. Seventeen experts participated in the internal consensus phase. Of 65 evaluated questionnaires, 1–3 questionnaires per domain and 11 short-term outcomes were submitted to the external survey (46 respondents). All short-term outcomes and at least one questionnaire per domain reached acceptance; the majority achieved consensus. The final PIC-CO set comprises seven questionnaires across six domains and 11 short-term outcomes, alongside a structured follow-up schedule. The PIC-CO set provides the first consensus-based, pragmatically implementable COS for pediatric critical care in German-speaking countries, enabling standardized long-term assessment for clinical practice and research. Substantial overlap with international initiatives was observed, with differences mainly related to cognitive assessment and domain structuring.