Pediatric Index of Cardiac Surgical Intensive Care Mortality Risk Score for Pediatric Cardiac Critical Care*

Abstract

This newly developed mortality score, PICSIM, consisting of 13 risk variables encompassing physiology, cardiovascular condition, and time of admission to the ICU showed better discrimination than Pediatric Index of Mortality-2, Pediatric Risk of Mortality-3, and STAT score and category for mortality in a multisite cohort of pediatric cardiac surgical patients. The introduction of the variable "admission time with respect to cardiac surgery" allowed prediction of mortality when patients are admitted to the ICU either before or after the index surgical procedure.

Morbidity and mortality prediction in pediatric heart surgery: Physiological profiles and surgical complexity

“…Discrimination for mortality in these models is similar to the older PRISM models 14 even though the observation time is substantially shorter, hospital outcome is used which has been harder to predict, only the first ICU admission is included, and the data sampling period is objectively assigned based on age and time to intervention. Importantly, the PRISM methodology was specifically developed to minimize the potential for institutional bias or “gaming” at the expense of model performance.…”

“…2,14 The PICSIM score uses post-operative therapies as well as a 12-hour post-operative sampling period for some of the physiological variables. The use of post-operative therapies in risk models can create bias.…”

“…The Pediatric Index of Cardiac Surgical Intensive Care Mortality (PICSIM) 14 overlaps with the Pediatric Index of Mortality (PIM) which did not perform well in cardiac surgery patients. 15,16 Since most of PICSIM’s predictive power comes from the surgical complexity score, its use to assess intensive care quality is limited.…”

“…2,14,18 Yet, modern risk assessment methods continue to focus on operative or intensive care mortality. In contrast, new morbidity rates assessed as functional status changes in critically ill children measured at hospital discharge are approximately twice as high as mortality rates and it has been suggested that functional morbidity is replacing mortality.…”

Current monitoring and innovative predictive modeling to improve care in the pediatric cardiac intensive care unit

“…While PEWS and other early warning scores are fairly sensitive and specific in their identification of clinical decompensation or mortality, they often have relatively low positive predictive values, and thus over-identify patients, making their overall impact on resource utilization less clear (45). There are additional scoring indices that have also been developed to predict mortality for intensive care patients, such as the PRISM-IV for physiologic instability and mortality risk for patients in pediatric intensive care units (46), and the PICSIM score, a post-surgical mortality risk index tool for patients in the PCICU (47). Table 1 summarizes many of these score-based acuity models and recent publications regarding their effectiveness.…”