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Prediction of mortality by application of PRISM score in intensive care unit
D Singhal1, N Kumar, J M Puliyel
1St. Stephen s Hospital, Tis Hazari, Delhi 110 054, India.
Insights
The Pediatric Risk of Mortality (PRISM) score effectively predicts mortality in Indian pediatric intensive care unit (PICU) patients. Observed deaths closely matched expected mortality rates across various PRISM score groups.
Area of Science:
- Pediatric critical care medicine
- Clinical epidemiology
- Biostatistics
Background:
- Accurate mortality prediction is crucial for resource allocation and quality improvement in Pediatric Intensive Care Units (PICUs).
- The Pediatric Risk of Mortality (PRISM) score is a widely used tool for predicting mortality in critically ill children.
- Validation of PRISM score under specific regional circumstances, such as in India, is essential.
Purpose of the Study:
- To evaluate the predictive accuracy of the Pediatric Risk of Mortality (PRISM) score for mortality in pediatric patients admitted to a tertiary care PICU in India.
- To compare the observed mortality rates with the expected mortality rates predicted by the PRISM score in this specific patient population.
Main Methods:
- A prospective study was conducted involving 100 consecutive pediatric patients admitted to the PICU.
- The PRISM score was calculated for each patient upon admission.
- Hospital outcomes (survival or death) were recorded, and predicted mortality was calculated using the standard PRISM formula.
Main Results:
- Out of 100 patients, 18 died and 82 survived.
- The study found no significant difference between expected and observed mortality rates across different PRISM score categories (p > 0.5).
- Receiver Operating Characteristic (ROC) analysis yielded an area under the curve of 72%, indicating good discriminatory ability.
Conclusions:
- The PRISM score demonstrates good predictive value for assessing mortality probability in children admitted to PICUs within the Indian context.
- The findings support the utility of the PRISM score as a reliable tool for risk stratification in Indian PICUs.
- Further studies may explore refinements or adaptations of the PRISM score for enhanced accuracy in diverse Indian healthcare settings.
Objective:
Prediction of mortality by application of Pediatric Risk of Mortality (PRISM) score in Pediatric Intensive Care Unit (PICU) patients under Indian circumstances.
Design:
Prospective study.
Setting:
PICU of a tertiary care multi-specialty hospital.
Methods:
100 sick pediatric patients admitted consecutively in PICU were taken for this study. PRISM score was calculated. Hospital outcome was recorded as (died/survived). The predicted death was calculated by the formula:
Results:
Of 100 patients, 18 died and 82 survived. By PRISM score 49 children had the score of 1-9. The expected death in this group was 10.3% (n = 5.03) and the observed death was 8.2% (n = 4). Among 45 children with the score of 10-19, the expected mortality was 21.2% (n = 9.6) and observed was 24.4% (n = 11). There were 3 patients with the score of 20-29, the expected mortality in this group was 39.3% (n = 1.18) and observed mortality 33.3% (n = 1). There were 3 patients with score > or = 30, observed death 66.3% (n = 2) and expected mortality was 74.7% (n = 2.24). There was no significant difference between expected and observed mortality in any group. (p > 0.5). ROC analysis showed area under the curve of 72%.
Conclusion:
PRISM score has good predictive value in assessing the probability of mortality in relation to children admitted to a PICU under Indian circumstances.