Application of the Pediatric Risk of Mortality Score (PRISM) score and determination of mortality risk factors in a tertiary pediatric intensive care unit

Abstract

INTRODUCTION:To establish disease severity at admission can be performed by way of the mortality prognostic. Nowadays the prognostic scores make part of quality control and research. The Pediatric Risk of Mortality (PRISM) is one of the scores used in the pediatric intensive care units.OBJECTIVES:The purpose of this study is the utilization of the PRISM and determination of mortality risk factors in a tertiary pediatric intensive care unit.METHODS: Retrospective cohort study, in a period of one year, at a general tertiary pediatric intensive care unit. The pediatric risk of mortality scores corresponding to the first 24 hours of hospitalization were recorded; additional data were collected to characterize the study population.RESULTS:359 patients were included; the variables that were found to be risk factors for death were multiple organ dysfunction syndrome on admission, mechanical ventilation, use of vasoactive drugs, hospital‐acquired infection, parenteral nutrition and duration of hospitalization (p < 0,0001). Fifty‐four patients (15%) died; median pediatric risk of mortality score was significantly lower in patients who survived (p = 0,0001). The ROC curve yielded a value of 0.76 (CI 95% 0,69–0,83) and the calibration was shown to be adequate.DISCUSSION:It is imperative for pediatric intensive care units to implement strict quality controls to identify groups at risk of death and to ensure the adequacy of treatment. Although some authors have shown that the PRISM score overestimates mortality and that it is not appropriate in specific pediatric populations, in this study pediatric risk of mortality showed satisfactory discriminatory performance in differentiating between survivors and non‐survivors.CONCLUSIONS:The pediatric risk of mortality score showed adequate discriminatory capacity and thus constitutes a useful tool for the assessment of prognosis for pediatric patients admitted to a tertiary pediatric intensive care units.

A Retrospective Evaluation of Morbidity Pattern and Outcome of Patients Admitted into a Pediatric Intensive Care Unit in India

“…The reported mortality varied from 9.8-35% in different series by other authors. (12)(13)(14)(15) The delayed arrival at our PICU because of the lack of information regarding set up of PICU within the last three years in different Government Hospital can be accounted for high mortality in our PICU. If children were received at earlier stage it could have resulted in change in current picture.…”

Pesquisas em pneumologia recentemente publicadas em revistas brasileiras

“…Costa et al (18) studied the application of the pediatric risk of mortality score. The authors concluded that the score shows adequate compliance is decreased close to end-expiratory lung volume in those patients.…”

Avaliação do prognóstico com a utilização de dois escores de mortalidade em terapia intensiva pediátrica de nível de atendimento terciário

“…O PRISM foi validado em 1988 e surgiu como um importante instrumento na terapia intensiva para prognosticar a evolução dos pacientes, separando os casos mais graves dos mais simples, reduzindo o número de variáveis fisiológicas requeridas nas UTIs e obtendo graduações dentro das variáveis remanescentes (Pollack et al, 1988 desempenho discriminatório e preditivo, sendo utilizado em muitas UTIP como indicador prognóstico para avaliação da gravidade da doença e da qualidade de atendimento (Costa et al, 2010).…”

“…O PIM2 , que é uma versão revisada do PIM (Shann et al, 1997) Leteurtre et al, 2001;El-Nawawy, 2003;Martha et al, 2005;Costa et al, 2010;El Karaksy et al, 2011;Garcia et al, 2011), assim como outros autores demonstraram que o PIM2 também é adequado em UTIP (Wolfler et al, 2007;Eulmesekian et al, 2007;Garcia e Piva, 2007;Ebenezer et al, 2011;Netto et al, 2011 Não há consenso na literatura, entre PRISM e PIM2, quanto à utilidade e padronização na admissão na terapia intensiva para as crianças e adolescentes, principalmente em uma UTI de nível de atendimento terciário (Shann et al, 1997) e não há comparação desses escores de mortalidade em pacientes heterogêneos em UTI pediátrica de nível de atendimento terciário, com alta taxa de complexidade e mortalidade.…”

“…Valores de PRISM acima de 10 são considerados para pacientes mais graves e, consequentemente, de alto risco para óbito (Costa et al, 2010) Embora haja versões mais recentes de ambos os escores, PIM3 e PRISM IV, seu uso ainda não está implementado na maioria das UTIP e precisam ser validados em contextos diferentes daqueles obtidos na população original.…”