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Performance of PRISM III and PELOD-2 scores in a pediatric intensive care unit
Jean-Pierre Gonçalves1,2, Milton Severo3,4, Carla Rocha5
1Pediatric Intensive Care Unit, Pediatric Integrated Hospital, São João Hospital, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal. pierre_3.14r@hotmail.com.
Insights
The Pediatric Risk of Mortality III (PRISM III) and Pediatric Logistic Organ Dysfunction 2 (PELOD-2) scores showed good mortality prediction in a Portuguese pediatric intensive care unit. However, PELOD-2 requires recalibration for improved reliability.
Area of Science:
- Pediatric intensive care
- Clinical epidemiology
- Health services research
Background:
- Pediatric Risk of Mortality III (PRISM III) and Pediatric Logistic Organ Dysfunction (PELOD) scores are established tools for assessing pediatric intensive care unit (PICU) performance and predicting mortality.
- The newer Pediatric Logistic Organ Dysfunction 2 (PELOD-2) score has demonstrated good discrimination and calibration in previous validations.
- This study evaluates and recalibrates these scores within a specific Portuguese pediatric population.
Purpose of the Study:
- To compare the predictive performance of the PRISM III and PELOD-2 scores for mortality in a Portuguese PICU.
- To recalibrate the PELOD-2 score for the Portuguese population to enhance its predictive accuracy.
- To assess the discrimination and calibration of both scoring systems.
Main Methods:
- A prospective cohort study was conducted, including 556 consecutive patients admitted to a PICU between January 2011 and December 2012.
- The performance of PRISM III and PELOD-2 was evaluated using standardized mortality ratio, discrimination (Area Under the Receiver Operating Characteristic curve), and calibration (Hosmer and Lemeshow goodness-of-fit test).
- Statistical analysis was performed to compare the observed mortality with the predicted mortality from both scores.
Main Results:
- Both PRISM III and PELOD-2 demonstrated good discrimination, with Area Under the ROC Curve values of 0.92 and 0.94, respectively.
- The observed mortality was 29 patients, while PRISM III predicted 30.8 deaths and PELOD-2 predicted 22.1 deaths.
- The Hosmer and Lemeshow test indicated good calibration for PRISM III (p=0.282) but poor calibration for PELOD-2 (p=0.022).
Conclusions:
- Both PRISM III and PELOD-2 exhibit strong discriminatory power for mortality prediction in the studied pediatric intensive care unit population.
- The PELOD-2 score requires recalibration to improve its reliability and accuracy in this specific Portuguese cohort.
- PRISM III demonstrated adequate calibration, suggesting its suitability for use in this population without immediate recalibration.
Unlabelled:
The study aims were to compare two models (The Pediatric Risk of Mortality III (PRISM III) and Pediatric Logistic Organ Dysfunction (PELOD-2)) for prediction of mortality in a pediatric intensive care unit (PICU) and recalibrate PELOD-2 in a Portuguese population. To achieve the previous goal, a prospective cohort study to evaluate score performance (standardized mortality ratio, discrimination, and calibration) for both models was performed. A total of 556 patients consecutively admitted to our PICU between January 2011 and December 2012 were included in the analysis. The median age was 65 months, with an interquartile range of 1 month to 17 years. The male-to-female ratio was 1.5. The median length of PICU stay was 3 days. The overall predicted number of deaths using PRISM III score was 30.8 patients whereas that by PELOD-2 was 22.1 patients. The observed mortality was 29 patients. The area under the receiver operating characteristics curve for the two models was 0.92 and 0.94, respectively. The Hosmer and Lemeshow goodness-of-fit test showed a good calibration only for PRISM III (PRISM III: χ (2) = 3.820, p = 0.282; PELOD-2: χ (2) = 9.576, p = 0.022).
Conclusions:
Both scores had good discrimination. PELOD-2 needs recalibration to be a better reliable prediction tool.
What Is Known:
• PRISM III (Pediatric Risk of Mortality III) and PELOD (Pediatric Logistic Organ Dysfunction) scores are frequently used to assess the performance of intensive care units and also for mortality prediction in the pediatric population. • Pediatric Logistic Organ Dysfunction 2 is the newer version of PELOD and has recently been validated with good discrimination and calibration. What is New: • In our population, both scores had good discrimination. • PELOD-2 needs recalibration to be a better reliable prediction tool.
