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[Prognostic indexes of mortality in pediatric intensive care units]
S Prieto Espuñes1, J López-Herce Cid, C Rey Galán
1Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Central de Asturias, Universidad de Oviedo, Asturias, España. msoledadp@yahoo.es
Insights
The Pediatric Index of Mortality (PIM) and PIM 2 scores demonstrated superior accuracy in predicting mortality for critically ill children compared to the Pediatric Risk of Mortality score (PRISM). These findings suggest PIM and PIM 2 are more reliable in Spanish pediatric intensive care units.
Area of Science:
- Pediatric critical care medicine
- Clinical epidemiology
- Health outcomes research
Context:
- Pediatric intensive care units (PICUs) rely on scoring systems to predict mortality.
- Accurate risk stratification is crucial for resource allocation and patient management.
- The validity of existing scores like PRISM, PIM, and PIM 2 needs continuous evaluation in diverse clinical settings.
Purpose:
- To evaluate the predictive performance of three pediatric mortality scoring systems: Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality (PIM), and PIM 2.
- To compare the discrimination and calibration of these scores in Spanish PICUs.
Summary:
- A prospective study of 241 critically ill children in two Spanish PICUs assessed PRISM, PIM, and PIM 2.
- PIM and PIM 2 exhibited better discrimination and calibration than PRISM.
- PRISM overestimated mortality, while PIM and PIM 2 showed acceptable calibration.
Impact:
- The study highlights the superior performance of PIM and PIM 2 over PRISM in a Spanish PICU population.
- Findings suggest PIM and PIM 2 may be more appropriate for risk stratification in this setting.
- Further validation in larger, multicenter studies is recommended to confirm these results.
Objective:
To assess the validity of the Pediatric Risk of Mortality score (PRISM), the Pediatric Index of Mortality (PIM) and the PIM 2 in two Spanish pediatric intensive care units.
Patients And Methods:
We prospectively studied 241 critically ill children consecutively admitted over a 6-month period. The overall performance of the scoring systems was assessed by the Standardized Mortality Ratio (SMR), comparing observed deaths with expected deaths by each index. Discrimination (the ability of the model to distinguish between patients who live and those who die) was quantified by calculating the area under the receiver operating characteristic (ROC) curve. Calibration (the accuracy of mortality risk predictions) was calculated with the Hosmer-Lemeshow goodness-of-fit test, in which statistical calibration is evidenced by p > 0.05.
Results:
The mortality rate was 4.1 %. PRISM overestimated mortality (SMR = 0.44). Discrimination was better for PRISM and PIM 2 than for PIM (areas under ROC curves: 0.883, 0.871, and 0.800 respectively), with no significant differences. Finally, calibration was acceptable for PIM 2 (x2 (8) = 4.8730, p 0.8461) and for PIM (x2 (8) = 8.0876, p 0.5174), but no statistical calibration was found for PRISM (x2 (8) = 15.0281, p 0.0133).
Conclusions:
PIM and PIM 2 showed better discrimination and calibration than PRISM in a heterogeneous group of children in Spanish critical care units. However, these results should be confirmed in a larger study.