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Evaluation of clinical scoring systems in critically ill infants and children
G Zobel1, M Kuttnig, H M Grubbauer
1Department of Paediatrics, University of Graz, Austria.
Insights
Four pediatric scoring systems were evaluated in critically ill children. Acute Physiologic Score for Children (APSC), Physiologic Stability Index (PSI), and Paediatric Risk of Mortality (PRISM) effectively predicted mortality, unlike the Therapeutic Intervention Scoring System (TISS).
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Outcomes Research
- Biostatistics
Background:
- Evaluating the efficacy of pediatric scoring systems is crucial for assessing critically ill children.
- Existing systems like APSC, PSI, PRISM, and TISS require validation in diverse pediatric populations.
- Accurate severity assessment aids in prognosis and resource allocation for pediatric intensive care.
Purpose of the Study:
- To compare the predictive accuracy of four scoring systems (APSC, PSI, PRISM, TISS) in critically ill pediatric patients.
- To determine which scoring systems best differentiate between survivors and non-survivors.
- To assess the prognostic value of these indices in a cohort of pediatric intensive care unit patients.
Main Methods:
- A prospective study evaluated 103 critically ill infants and children classified under CCS class IV.
- Admission scores from APSC, PSI, PRISM, and TISS were recorded and analyzed.
- Statistical comparisons, including Receiver Operating Characteristic (ROC) curve analysis, were performed between survivors and non-survivors.
Main Results:
- Admission scores were significantly higher in non-survivors across APSC, PSI, and PRISM (p < 0.001), and TISS (p < 0.025).
- APSC, PSI, and PRISM demonstrated significant differences between survivors and non-survivors (p < 0.01).
- Predictive accuracy for mortality was high for APSC (80%), PSI (80.5%), and PRISM (80%); ROC analysis showed physiological scores outperformed TISS (p < 0.001).
Conclusions:
- APSC, PSI, and PRISM are excellent tools for describing illness severity and providing prognostic information in critically ill pediatric patients.
- TISS provides valuable insights into the level of therapeutic support required.
- These findings support the use of APSC, PSI, and PRISM for risk stratification in pediatric intensive care.
Abstract:
Four scoring systems, the Acute Physiologic Score for Children (APSC), the Physiologic Stability Index (PSI), the Paediatric Risk of Mortality (PRISM) and the Therapeutic Intervention Scoring System (TISS), were evaluated for 103 critically ill infants and children according to the Clinical Classification System (CCS) class IV. The admission scores were higher for children who died than those who lived (APSC, PSI, PRISM p less than 0.001, TISS p <0.025). In addition, the mean APSC and PSI showed significant differences (p less than 0.01) between survivors (S) and nonsurvivors (NS) in all patients, mean PRISM showed significant differences (p less than 0.01) between S and NS in all but renal failure patients and the mean TISS showed only significant differences (p less than 0.01) between S and NS with primary cardiovascular and respiratory diseases. The mortality rate was 30%. Using the 0.5 predicted risk rate, total correct prediction of admission APSC, PSI, and PRISM was 80%, 80.5% and 80% respectively. Receiver Operating Characteristic (ROC) curves drawn for each severity index were in a discriminating position. There were no significant differences between the areas under the ROC curves of the physiological scores. However, there was a significant difference between the physiologic scores and TISS (p less than 0.001). Admission APSC, PSI and PRISM excellently describe severity of illness and give prognostic information in critically ill paediatric patients. In addition, TISS gives information about the therapeutic support needed.