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The Comparison of PRISM and PIM scoring systems for mortality risk in infantile intensive care
Esra Arun Ozer1, Asli Kizilgunesler, Berrak Sarioglu
1SSK Tepecik Teaching Hospital, Clinic of Pediatrics,Yenisehir, Izmir,Turkey. eozer@deu.edu.tr
Insights
Pediatric scoring systems like PIM and PRISM may underestimate mortality risk in infants. The Pediatric Index of Mortality (PIM) showed potential for predicting infant mortality, especially with population-specific revisions.
Area of Science:
- Pediatric Intensive Care
- Medical Scoring Systems
- Mortality Prediction
Background:
- Pediatric intensive care effectiveness evaluation requires reliable mortality risk prediction tools.
- The Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality (PIM) scores are established tools for predicting pediatric ICU mortality.
- Assessing the population-independence and effectiveness of these scoring systems is crucial.
Purpose of the Study:
- To evaluate the effectiveness and population-independence of PRISM and PIM scoring systems.
- To determine the accuracy of these scores in predicting mortality among non-surgical infants in the ICU.
- To identify potential areas for improvement in pediatric mortality prediction models.
Main Methods:
- Prospective calculation of PRISM and PIM scores for 105 non-surgical infants over one year.
- Statistical analysis including SMR, Z scores, Hosmer and Lemeshow test, and ROC analysis.
- Assessment of scoring system performance and discriminatory function.
Main Results:
- Both PIM and PRISM scores indicated higher mortality and poor performance, underestimating risk across most groups.
- Satisfactory overall calibration was observed for both systems via the Hosmer and Lemeshow test.
- ROC analysis revealed poor discriminatory function for both, though PIM showed marginally acceptable performance, especially for infants with chronic disorders.
Conclusions:
- Existing PRISM and PIM scores may underestimate mortality risk in pediatric ICU populations.
- The PIM score demonstrated potential for improved mortality prediction in infants, particularly when adapted to specific population characteristics.
- Revisions to scoring systems considering local mortality rates and prevalence of chronic conditions may enhance predictive accuracy for pediatric intensive care.
Abstract:
Scoring systems that predict the risk of mortality for children in an intensive care unit (ICU) are needed for the evaluation of the effectiveness of pediatric intensive care. The Pediatric Risk of Mortality (PRISM) and the Pediatric Index of Mortality (PIM) scores have been developed to predict mortality among children in the ICU. The purpose of this study was to evaluate whether these systems are effective and population-independent. PRISM and PIM scores were calculated prospectively during a 1-year period solely on 105 non-surgical infants admitted to the ICU. Statistical analysis was performed to assess the performance of the scoring systems. There were 29 (27.6 per cent) deaths and 76 (72.4 per cent) survivors. SMR and Z scores for PIM and PRISM signified higher mortality and poor performance. Prediction of mortality by the scoring systems appeared to be underestimated in almost all risk groups. The Hosmer and Lemeshow test showed a satisfactory overall calibration of both scoring systems. Although ROC analysis showed a poor discriminatory function of both scores, a marginally acceptable performance for PIM was observed. The ROC curve also showed an acceptable performance for PIM, for patients with pre-existent chronic disorder. Although care must be taken not to overstate the importance of our results, we believe that when revised according to the characteristics of the population, PIM may perform well in predicting the mortality risk for infants in the ICU, especially in countries where the mortality rate is relatively high and pre-existent chronic disorders are more common.
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