Evaluation of Pediatric Risk of Mortality (PRISM) scoring in African children with falciparum malaria

Gérardin, Patrick; Rogier, Christophe; Leteurtre, Stéphane; Jouvencel, P.; Ka, Amadou Sidy; Imbert, Patrick

doi:10.1097/01.pcc.0000192321.66637.e6

Cited by 13 publications

(18 citation statements)

References 8 publications

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“…Although some authors have shown that the PRISM score overestimated mortality13-16 and that it is not appropriate in specific pediatric populations, such as post‐trauma patients,34 patients with acute renal failure35 and related to Plasmodium falciparum malaria,36 in this study PRISM showed satisfactory discriminatory performance in differentiating survivors from non‐survivors, supporting the conclusion that higher PRISM scores are correlated with increased risk of death, similar other studies 7,10-12,27. …”

Section: Discussionsupporting

confidence: 84%

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

Costa

Delgado

Ferraro

et al. 2010

Clinics

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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.

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Section: Discussionsupporting

confidence: 84%

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

Costa

Delgado

Ferraro

et al. 2010

Clinics

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“…Other published paediatric risk scores were evaluated in the FEAST derivation and validation datasets. PRISM III was developed in paediatric intensive care units in the USA and has been validated in a variety of settings [ 10 , 24 – 28 ]. The Bedside Pediatric Early Warning System score (PEWS) was developed in Canada to quantify severity of children in hospitalised children and help with referral to critical care experts [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Predicting mortality in sick African children: the FEAST Paediatric Emergency Triage (PET) Score

George

Walker

Kiguli

et al. 2015

BMC Med

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BackgroundMortality in paediatric emergency care units in Africa often occurs within the first 24 h of admission and remains high. Alongside effective triage systems, a practical clinical bedside risk score to identify those at greatest risk could contribute to reducing mortality.MethodsData collected during the Fluid As Expansive Supportive Therapy (FEAST) trial, a multi-centre trial involving 3,170 severely ill African children, were analysed to identify clinical and laboratory prognostic factors for mortality. Multivariable Cox regression was used to build a model in this derivation dataset based on clinical parameters that could be quickly and easily assessed at the bedside. A score developed from the model coefficients was externally validated in two admissions datasets from Kilifi District Hospital, Kenya, and compared to published risk scores using Area Under the Receiver Operating Curve (AUROC) and Hosmer-Lemeshow tests. The Net Reclassification Index (NRI) was used to identify additional laboratory prognostic factors.ResultsA risk score using 8 clinical variables (temperature, heart rate, capillary refill time, conscious level, severe pallor, respiratory distress, lung crepitations, and weak pulse volume) was developed. The score ranged from 0–10 and had an AUROC of 0.82 (95 % CI, 0.77–0.87) in the FEAST trial derivation set. In the independent validation datasets, the score had an AUROC of 0.77 (95 % CI, 0.72–0.82) amongst admissions to a paediatric high dependency ward and 0.86 (95 % CI, 0.82–0.89) amongst general paediatric admissions. This discriminative ability was similar to, or better than other risk scores in the validation datasets. NRI identified lactate, blood urea nitrogen, and pH to be important prognostic laboratory variables that could add information to the clinical score.ConclusionsEight clinical prognostic factors that could be rapidly assessed by healthcare staff for triage were combined to create the FEAST Paediatric Emergency Triage (PET) score and externally validated. The score discriminated those at highest risk of fatal outcome at the point of hospital admission and compared well to other published risk scores. Further laboratory tests were also identified as prognostic factors which could be added if resources were available or as indices of severity for comparison between centres in future research studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0407-3) contains supplementary material, which is available to authorized users.

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“…This could lead to misleading interpretations of severity and fatality rates [2,3,21,23-26,28]. In this series, the high lethality could be explained by the extreme severity of our cases, as reflected by the high frequency of MOD syndrome (91%), indisputable indications for resuscitation, and PRISM score in ventilated children (median PRISM h24 : 14, IQR: 10–19) twice as high as in our hospital's overall SM cases at the same period (median PRISM h24 : 7, IQR: 3–13), of which fatality rate was 12% [29,30]. However, the lethality in ventilated children was close to those seen in adults with malaria treated in ICU's [14-17,31].…”

Section: Discussionmentioning

confidence: 93%

Outcome of life-threatening malaria in African children requiring endotracheal intubation

Gérardin

Rogier

et al. 2007

Malar J

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Evaluation of Pediatric Risk of Mortality (PRISM) scoring in African children with falciparum malaria

Cited by 13 publications

References 8 publications

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

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

Predicting mortality in sick African children: the FEAST Paediatric Emergency Triage (PET) Score

Outcome of life-threatening malaria in African children requiring endotracheal intubation

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