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Risk of mortality in pediatric intensive care unit, assessed by PRISM-III

N Bilan1, B A Galehgolab, A Emadaddin

  • 1Tuberculosis and Lung Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran.

Pakistan Journal of Biological Sciences : PJBS
|July 8, 2009
PubMed

Insights

The Pediatric Risk of Mortality III (PRISM-III) score accurately predicted mortality in a pediatric intensive care unit (PICU). This scoring system demonstrated excellent calibration, with observed mortality closely matching expected rates.

Area of Science:

  • Pediatric critical care medicine
  • Clinical epidemiology

Background:

  • Accurate mortality prediction is crucial for resource allocation and quality improvement in pediatric intensive care units (PICUs).
  • The Pediatric Risk of Mortality III (PRISM-III) is a widely used scoring system for predicting mortality in critically ill children.

Purpose of the Study:

  • To evaluate the performance and calibration of the PRISM-III scoring system in predicting short-term mortality among infants and children admitted to a PICU.
  • To assess the predictive accuracy of PRISM-III using statistical methods like the Hosmer and Lemeshow goodness-of-fit test and Receiver Operating Characteristic (ROC) curve analysis.

Main Methods:

  • A prospective study involving 221 infants and children consecutively admitted to the PICU of Tabriz Children's Hospital over 13 months.
  • Collection of data for PRISM-III score calculation within the first 24 hours of PICU admission.
  • Statistical evaluation using Hosmer and Lemeshow goodness-of-fit test, ROC curve analysis, and comparison of observed (O) versus expected (E) mortality rates (O/E ratio).

Main Results:

  • The mean PRISM-III score was 14.22 ± 9.57.
  • ROC analysis showed a strong predictive power for PRISM-III, with an area under the curve of 0.898.
  • The study demonstrated excellent model fit (goodness-of-fit p-value = 0.161) and high calibration (O/E ratio = 1.005), with observed mortality at 9.05% and expected mortality at 9%.

Conclusions:

  • The PRISM-III scoring system is a reliable and well-calibrated tool for predicting short-term mortality in the studied PICU population.
  • The findings support the continued use of PRISM-III for risk stratification and quality assessment in pediatric critical care settings.

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