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Simplified PRISM III score and outcome in the pediatric intensive care unit
Ana Lilia Ponce-Ponce De León1, Gustavo Romero-Gutiérrez, Carlos Aldana Valenzuela
1Unit of Clinical Epidemiological Research, Department of Pediatrics, Mexican Institute of Social Security, Leon, Mexico.
Insights
The Pediatric Risk of Mortality III (PRISM III) score effectively predicts infant mortality in the pediatric intensive care unit (PICU). A simplified version using four key variables may improve cost-effectiveness, especially in developing countries.
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Neonatal Research
Background:
- The Pediatric Risk of Mortality III (PRISM III) score is used to assess infant outcomes in the pediatric intensive care unit (PICU).
- Evaluating the association of the PRISM III score with infant outcomes is crucial for improving care.
- Simplifying the PRISM III score could enhance its applicability and reduce costs.
Purpose of the Study:
- To evaluate the association between the PRISM III score and infant outcomes in the PICU.
- To determine if the PRISM III score can be simplified for practical use.
- To identify key variables contributing to mortality prediction in critically ill infants.
Main Methods:
- A prospective cohort study involving 170 infants admitted to the PICU.
- PRISM III score calculated using 17 physiologic variables within the first 8 hours of admission.
- Statistical analysis included logistic regression, odds ratios (OR) with 95% confidence intervals (95% CI), and receiver operating characteristic (ROC) curve analysis.
Main Results:
- A mortality rate of 24.7% (42 deaths) was observed, with septic shock and head trauma as primary causes.
- The PRISM III score demonstrated a sensitivity of 0.71 and specificity of 0.64 for predicting mortality.
- Four significant variables identified: abnormal pupillary reflexes (OR 9.9), acidosis (OR 3.1), blood urea nitrogen (OR 1.03), and white blood cell count (OR 1.02).
Conclusions:
- The PRISM III score exhibits good sensitivity and specificity in predicting mortality in the PICU setting.
- A simplified PRISM III score, utilizing only the four significant variables, is proposed.
- This modified score has the potential to reduce patient care costs, particularly in resource-limited PICUs in developing nations.
Background:
To evaluate the association of the PRISM III (pediatric risk of mortality) score with the infant outcome in the pediatric intensive care unit (PICU), and to determine if this score could be simplified.
Methods:
A prospective cohort study was carried out with 170 infants who were consecutively admitted to the PICU. The PRISM III score with 17 physiologic variables was performed during the first 8 h of admission to the unit. Statistical analysis was done with logistic regression, odds ratios (OR) with 95% confidence intervals (95% CI), and receiver operating curve. The Alfa value was set at 0.05.
Results:
There were 42 deaths (24.7%). The two main causes of death were septic shock (28.6%) and head trauma (16.7%). The PRISM III score had a sensitivity of 0.71, and a specificity of 0.64 as a mortality predictor. Out of the 17 physiologic variables only four of them were significant: abnormal pupillary reflexes OR 9.9 (95% CI, 3.5-28.4), acidosis OR 3.1 (95% CI, 2.0-4.9), blood urea nitrogen concentration OR 1.03 (95% CI, 1.01-1.04), and white blood cell count OR 1.02 (95% CI, 1.01-1.03). The whole logistic regression model had a coefficient of determination R(2) = 0.219, P < 0.001.
Conclusions:
In this setting, the PRISM III score had good sensitivity and specificity to predict mortality. This score could be simplified using only the four variables that were significant in this study. This modified PRISM III score could reduce the cost of patient care especially in developing countries PICU.
