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[Estimation of the validity of pediatric severity rating scales in multidisciplinary children's intensive care units]
Insights
The Pediatric Index of Mortality II (PIM II) score demonstrated the highest validity in assessing disease severity in pediatric intensive care units. Other scores like PRISM and PELOD are useful for specific high-risk patient subgroups.
Area of Science:
- Pediatric critical care medicine
- Clinical epidemiology
- Health outcomes research
Context:
- Pediatric intensive care units (PICUs) require accurate tools to assess patient severity.
- Existing pediatric severity scores (PRISM, PIM II, PELOD) need validation in diverse PICU settings.
- Multicenter studies are crucial for generalizability of findings.
Purpose:
- To evaluate and compare the validity of three pediatric severity rating scales: Pediatric Risk of Mortality (PRISM) III, Pediatric Index of Mortality (PIM) II, and Scoring Severity-Based on Length of Stay (PELOD).
- To determine which score best predicts 28-day mortality in a general PICU population.
- To assess the calibration of these scores against observed mortality rates.
Summary:
- A prospective, observational multicenter study involving 226 pediatric patients (mean age 4.1 years) was conducted.
- PIM II exhibited the best discriminative ability (Area Under the ROC Curve = 0.833) and calibration (Hosmer-Lemeshow test p=0.084).
- PRISM and PELOD showed lower validity but may be useful for specific high-risk patient subgroups.
Impact:
- Findings suggest PIM II is the most reliable severity score for general PICU use.
- This research aids clinicians in selecting appropriate tools for patient stratification and resource allocation.
- The study contributes to evidence-based practice in pediatric critical care by validating severity assessment tools.
Abstract:
The aim of this study was to estimate the validity of pediatric severity rating scales at general pediatric intensive care units. This was a prospective, observational multicenter study that was performed from November 1, 2007, to January 31, 2008. The end points were the estimation of the severity of disease, by using the PRISM, PIM II, RELOD scores, and 28-day survival. The investigation covered 226 patients whose mean age was 4.1 +/- 0.3 years. Twelve (5.3%) patients died during the study. The Medcalc computer program was employed for statistical analysis. The area under the receiver operating curve (ROC) was 0.623 +/- 0.116 for PRISM (p = 0.289); 0641 +/- 0.116 for PELOD (p = 0.224); 0.833 +/- 0.096 for PIM II (p < 0.001). The calibration of scores according to the intervals of mortality risk (Hosmer-Lemeshov test) showed that the observed and predicted mortality rates were similar for PIM II scores (chi2 = 8.23; p = 0.084) and were different for PRISM scores (chi2 = 203.5; p < 0.001) and PELOD ones (chi2 = 26.16; p < 0.001). Thus, the PIM II scores showed the best validity. PRISM and PELOD can be used to estimate the severity of disease in individual subgroups of high mortality-risk patients.
