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[Comparison of two prognostic scores (PRISM and PIM) at a pediatric intensive care unit]
Vanessa Feller Martha1, Pedro Celiny Ramos Garcia, Jefferson Pedro Piva
1Unidade de Terapia Intensiva Pediátrica, Hospital Moinhos de Vento, Porto Alegre, RS.
Insights
The Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality (PIM) scores demonstrate comparable performance in predicting outcomes for pediatric intensive care unit patients, aiding in prognostic evaluation.
Area of Science:
- Pediatric critical care medicine
- Clinical epidemiology
- Biostatistics
Background:
- Pediatric intensive care units (PICUs) rely on scoring systems to predict patient mortality.
- The Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality (PIM) are commonly used prognostic tools.
- Evaluating the performance of these scores in local settings is crucial for accurate patient management.
Purpose of the Study:
- To compare the predictive performance of the PRISM and PIM scores.
- To assess the relationship between observed and predicted mortality in a general PICU population.
- To determine the utility of these scores for prognostic evaluation.
Main Methods:
- A cohort study was conducted over one year in a general PICU.
- PRISM and PIM scores were calculated for admitted patients using established formulas.
- Statistical analyses included goodness-of-fit tests (Hosmer-Lemeshow), ROC curves, and correlation tests (Spearman).
Main Results:
- Of 421 patients, 7.83% (33) died. PRISM predicted 30.84% mortality (SMR 1.07), while PIM predicted 26.13% (SMR 1.26).
- PRISM showed better calibration (Hosmer-Lemeshow p=0.100) compared to PIM (p<0.001).
- Both scores demonstrated good discrimination (ROC AUC for PRISM: 0.870; PIM: 0.845), with a significant correlation between scores (r=0.65, p<0.001).
Conclusions:
- Both PRISM and PIM are effective tools for discriminating between survivors and non-survivors in a PICU setting.
- While PIM was less well-calibrated, both scores offer comparable performance for prognostic evaluation of pediatric patients.
- These findings support the use of PRISM and PIM as valuable prognostic tools in general PICUs.
Objective:
To compare the performance of the PRISM (Pediatric Risk of Mortality) and the PIM (Pediatric Index of Mortality) scores at a general pediatric intensive care unit, investigating the relation between observed mortality and survival and predicted mortality and survival.
Methods:
A contemporary cohort study undertaken between 1 June 1999 and 31 May 2000 at the Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas pediatric intensive care unit. The inclusion criteria and the PRISM and PIM calculations were performed as set out in the original articles and using the formulae as published. Statistical analysis for model evaluation employed the Flora z test, Hosmer-Lemeshow goodness-of-fit test, ROC curve (receiver operating characteristic) and Spearman's correlation tests. The study was approved by the institution's Ethics Committee.
Results:
Four hundred and ninety-eight patients were admitted to the pediatric intensive care unit, 77 of whom presented exclusion criteria. Thirty-three (7.83%) of the 421 patients studied died and 388 patients were discharged. Estimated mortality by PRISM was 30.84 (7.22%) with a standardized mortality rate of 1.07 (0.74-1.50), z = -0.45 and by PIM this was 26.13 (6.21%) with a standardized mortality rate of 1.26 (0.87-1.77), z = -1.14. The Hosmer-Lemeshow test gave a chi-square of 9.23 (p = 0.100) for PRISM and 27.986 (p < 0.001) for PIM. The area under the ROC curve was 0.870 (0.810-0.930) for PRISM and 0.845 (0.769-0.920) for PIM. The Spearman test returned r = 0.65 (p < 0.001).
Conclusion:
Analyzing the tests we can observe that, although the PIM test was less well calibrated overall, both PRISM and PIM offer a good capacity for discriminating between survivors and moribund patients. They are tools with comparable performance at the prognostic evaluation of the pediatric patients admitted to our unit.
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