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Effect of training and strict guidelines on the reliability of risk adjustment systems in paediatric intensive care

Jolanda G van Keulen1, Reinoud J B J Gemke, Kees H Polderman

  • 1Department of Paediatrics, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.

Intensive Care Medicine
|July 7, 2005
PubMed

Insights

Training significantly improved the reliability of the Paediatric Risk of Mortality (PRISM) and Paediatric Index of Mortality (PIM) scoring systems in pediatric intensive care units. This enhanced agreement is crucial for accurate quality benchmarking.

Area of Science:

  • Pediatric Intensive Care
  • Clinical Risk Adjustment
  • Healthcare Quality Improvement

Background:

  • Risk-adjustment systems in clinical practice often suffer from interobserver variability.
  • This variability has not been extensively studied in the pediatric intensive care setting.
  • Improving reliability is key for accurate quality assessment and benchmarking.

Purpose of the Study:

  • To assess the reliability of the Paediatric Risk of Mortality (PRISM) and Paediatric Index of Mortality (PIM) scoring systems.
  • To evaluate the impact of a specialized training program on the reliability of these pediatric scoring systems.
  • To determine if training can reduce interobserver variability in daily clinical practice.

Main Methods:

  • A prospective, observational, multi-centered cohort study was conducted.
  • Twenty-seven physicians from five PICUs assessed 20 patients using PRISM and PIM scores.
  • Physicians' scoring reliability was compared before and after a dedicated training program using intraclass correlation coefficients.

Main Results:

  • Before training, significant interobserver variability was noted for both PRISM (ICC 0.24-0.73) and PIM (ICC 0.16-0.33) scores.
  • Following training and guideline implementation, interobserver agreement substantially increased (PRISM ICC 0.74-0.86; PIM ICC 0.88-0.95).
  • Despite improvements, some degree of scoring variability persisted post-training.

Conclusions:

  • The reliability of PRISM and PIM scoring systems in routine pediatric intensive care is lower than anticipated.
  • A structured training program and clear guidelines can significantly enhance interobserver agreement for these risk-adjustment tools.
  • These findings underscore the importance of training and guidelines when utilizing PRISM and PIM for benchmarking and quality comparisons between PICUs.
Abstract

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