Comparison of two prognostic scores (PRISM and PIM) at a pediatric intensive care unit

Abstract

Resultados: Internaram na unidade de terapia intensiva pediátri-ca 498 pacientes, sendo 77 excluídos. Dos 421 pacientes estudados, 33 (7,83%) foram a óbito. A mortalidade estimada pelo PRISM foi de 30,84 (7,22%), com standardized mortality rate 1,07 (0,74-1,50), z = -0,45. Pelo PIM, foi de 26,13 (6,21%), com standardized mortality rate 1,26 (0,87-1,77), z = -1,14. O teste de ajuste de Hosmer-Lemeshow obteve um qui-quadrado 9,23 (p = 0,100) para o PRISM e 27,986 (p < 0,001) para o PIM. A área abaixo da curva ROC foi 0,870 (0,810-0,930) para o PRISM e 0,845 (0,769-0,920) para o PIM. Teste de Spearman r = 0,65 (p < 0,001).Conclusão: Na análise dos testes podemos constatar que, embora o PIM apresente uma pior calibração no conjunto dos resultados, tanto o PRISM como o PIM apresentaram boa capacidade de discriminar entre sobreviventes e não sobreviventes, constituindo-se em ferramentas de desempenho comparáveis na avaliação prognóstica de pacientes pediá-tricos admitidos em nossa unidade. AbstractObjective: To compare the performance of the PRISM (Pediatric Risk of Mortality) and the PIM (Pediatric Index of Mortality) scores at a general pediatric intensive care unit, investigating the relation between observed mortality and survival and predicted mortality and survival.Methods: A contemporary cohort study undertaken between 1 June 1999 and 31 May 2000 at the Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas pediatric intensive care unit. The inclusion criteria and the PRISM and PIM calculations were performed as set out in the original articles and using the formulae as published. Statistical analysis for model evaluation employed the Flora z test, Hosmer-Lemeshow goodness-of-fit test, ROC curve (receiver operating characteristic) and Spearmans correlation tests. The study was approved by the institutions Ethics CommitteeResults: Four hundred and ninety-eight patients were admitted to the pediatric intensive care unit, 77 of whom presented exclusion criteria. Thirty-three (7.83%) of the 421 patients studied died and 388 patients were discharged. Estimated mortality by PRISM was 30.84 (7.22%) with a standardized mortality rate of 1.07 (0.74-1.50), z = -0.45 and by PIM this was 26.13 (6.21%) with a standardized mortality rate of 1.26 (0.87-1.77), z = -1.14. The Hosmer-Lemeshow test gave a chi-square of 9.23 (p = 0.100) for PRISM and 27.986 (p < 0.001) for PIM. The area under the ROC curve was 0.870 (0.810-0.930) for PRISM and 0.845 (0.769-0.920) for PIM. The Spearman test returned r = 0.65 (p < 0.001).Conclusion: Analyzing the tests we can observe that, although the PIM test was less well calibrated overall, both PRISM and PIM offer a good capacity for discriminating between survivors and moribund patients. They are tools with comparable performance at the prognostic evaluation of the pediatric patients admitted to our unit.

Performance of PRISM (Pediatric Risk of Mortality) score and PIM (Pediatric Index of Mortality) score in a tertiary care pediatric ICU

“…The reasons for the under prediction and poor calibration of the PIM score could be considered to be the small number of deaths at each risk interval. 14,15 Eight variables in the PIM score recorded just at the time of admission may not represent the actual magnitude of the organ dysfunction leading to death. This could be the reason that the Standardized Mortality Ratio (SMR) of the present study population with PIM score was 3.3 as compared to 1 for the PRISM score.…”

“…Such disparity in the SMR on comparing the PIM and PRISM score has not been observed in other studies. 5,15 Due to the availability of a specialized emergency medical services (EMS) set-up at our facility, patients are often stabilized before they are transferred to the PICU. Moreover, it is ensured that the patients do not have unsteady physiological parameters during transfer.…”

Clinical and molecular characteristics of invasive community-acquired Staphylococcus aureusinfections in Chinese children

“…The pediatric risk of mortality (PRISM) score has been developed and validated in several centers in the United States in pediatric patients [9]-[11]. It was reported that the PRISM score could directly reflect the severity of the disease, and has been widely used for predicting patients’ death or survival, as reported in Portugal in 2005, the United Kingdom and Senegal in 2006, and India in 2010 [12]-[15]. …”

Validation of pediatric index of mortality 2 (PIM2) in a single pediatric intensive care unit in Japan

“…Although PRISM and PIM have been shown to be able to differentiate between survival and death in the ICU setting, the simulated model results have been found to be somewhat different from real situations and therefore Intensive Care Med (2012) 38:649-654 DOI 10.1007/s00134-011-2460-5 ORIGINAL needed standardization [3,[5][6][7][8][9][10][11][12]. Prior to implementation of these tools in a new country, it is important to examine their performance [13].…”