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Pediatric risk of mortality scoring overestimates severity of illness in infants
1Sheffield Children's Hospital, UK.
Insights
The Pediatric Risk of Mortality (PRISM) score overestimates illness severity in infants admitted to intensive care. This scoring system requires reappraisal for infant populations to improve accuracy.
Area of Science:
- Pediatric critical care medicine
- Clinical scoring systems
- Healthcare outcomes research
Background:
- The Pediatric Risk of Mortality (PRISM) score is a tool used to assess illness severity in pediatric intensive care units (PICUs).
- Validation of existing scoring systems is crucial for accurate patient management and resource allocation in PICUs.
- Previous studies have shown variability in the performance of PRISM across different populations and settings.
Purpose of the Study:
- To validate the Pediatric Risk of Mortality (PRISM) scoring system in a cohort of infants and children admitted to a pediatric intensive care unit.
- To assess the accuracy of PRISM in predicting mortality for different age groups within the pediatric population.
Main Methods:
- A validation cohort study was conducted in a tertiary care children's hospital with a dedicated pediatric ICU.
- PRISM scoring was implemented as a routine procedure for all admitted patients within the first 24 hours.
- Data were collected over an 18-month period, including demographic information and PRISM parameters, with some discretionary measurements.
Main Results:
- PRISM scores were obtained for 380 out of 433 (88%) patients. A complete score was achieved in 24% of cases.
- Overall observed mortality was significantly better than predicted (p < .05).
- The PRISM model performed well for children (p > .75) but significantly overestimated illness severity in infants (p < .01).
Conclusions:
- The PRISM scoring system overestimates the severity of illness in infants treated in our center.
- PRISM scores may not be institutionally independent, questioning the justification of inter-unit comparisons.
- A revision of the parameter ranges for infants within the PRISM scoring system is recommended to enhance its accuracy.
Objective:
To validate Pediatric Risk of Mortality (PRISM) scoring in infants and children admitted for intensive care.
Design:
Validation cohort.
Setting:
A five-bed pediatric ICU and three cots providing intensive care for surgical neonates, within a 159-bed tertiary care children's hospital.
Patients:
All patients admitted for intensive care during an 18-month period, January 1990 to July 1991.
Methods:
Admission (first 24 hrs) PRISM scoring was introduced as a routine procedure. Discretion was allowed in requesting arterial blood gas measurements and clotting studies. All other parameters were intended to be measured on all patients.
Measurements And Main Results:
PRISM scores were obtained on 380 (88%) of 433 patients. Median age was 15 months. A complete PRISM score was obtained in 24% of cases and a score as intended (i.e., allowing discretionary omissions) was obtained in 56% of patients. Comparison of observed and predicted mortality rates using chi square goodness-of-fit tests showed a significantly better observed outcome for all patients (chi 2(5) = 12.04, p < .05). In-depth analysis indicates that the model works well for children (chi 2(5) = 1.80, p > .75), but that observed outcome is significantly better than predicted for infants (chi 2(5) = 17.46, p < .01). Underscoring of children is not the cause of this finding.
Conclusions:
In our center, PRISM scoring overestimates severity of illness in infants. PRISM scoring is not institutionally independent and therefore, at present, a comparison between units may not be justified. A reappraisal of the parameter ranges for infants is suggested.
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