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Risk adjusted mortality of critical illness in a defined geographical region
A J Henderson1, L Garland, S Warne
1Institute of Child Health, Bristol Royal Hospital for Children, Bristol, UK. a.j.henderson@bris.ac.uk
Insights
The Paediatric Risk of Mortality (PRISM) score accurately predicted outcomes for critically ill UK children. High-risk children had better survival rates in specialized paediatric intensive care units.
Area of Science:
- Pediatric critical care medicine
- Healthcare outcomes research
- Clinical risk stratification
Background:
- The Paediatric Risk of Mortality (PRISM) score is a tool used to assess the severity of illness in critically ill children.
- Evaluating the performance of risk scores in diverse populations is crucial for accurate mortality prediction.
Purpose of the Study:
- To assess the performance of the PRISM score in a UK pediatric population.
- To analyze severity-adjusted mortality rates among critically ill children (<16 years) in a specific UK region.
Main Methods:
- Observational study design.
- Inclusion of critically ill children (<16 years) admitted to hospitals in the South West Region, UK.
- Data collection over a two-year period (December 1996 - November 1998).
Main Results:
- The PRISM score demonstrated acceptable performance within this UK pediatric cohort.
- Observed mortality rates closely matched PRISM-predicted mortality.
- Children with a PRISM score indicating ≥30% mortality risk had higher odds of death in general ICUs compared to tertiary pediatric ICUs.
Conclusions:
- Critically ill children with high predicted mortality (PRISM ≥30%) experienced better survival in tertiary pediatric ICUs than in general ICUs.
- No significant difference in mortality risk was observed for children with lower predicted mortality (<30%) between general and tertiary pediatric ICUs.
Aims:
To evaluate the performance of the Paediatric Risk of Mortality (PRISM) score in a population of UK children and to use this score to examine severity of illness adjusted mortality of critically ill children <16 years old in a defined geographical region.
Methods:
Observational study of a defined population of critically ill children (<16 years old) admitted to hospitals in the South West Region between 1 December 1996 and 30 November 1998.
Results:
Data were collected from 1148 eligible admissions. PRISM was found to perform acceptably in this population. There was no significant difference between the overall number of observed deaths and those predicted by PRISM. Admissions with mortality risk 30% or greater had significantly greater odds ratio for death in general intensive care units compared with the tertiary paediatric intensive care unit.
Conclusions:
Children with a high initial risk of mortality based on PRISM score were significantly more likely to survive in a tertiary paediatric intensive care unit than in general intensive care units in this region. However, there was no evidence from this study that admissions with lower mortality risk than 30% had significantly worse mortality in non-tertiary general units than in tertiary paediatric intensive care units.