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Comparison of Severity Scoring Systems in a Pediatric Intensive Care Unit in India: A Single-Center Prospective,

Vinayak K Patki1, Sandeep Raina2, Jennifer V Antin2

  • 1Department of Pediatrics, Institute of Medical Science & Research, Vidyagiri, Satara, Maharashtra, India.

Journal of Pediatric Intensive Care
|May 11, 2019
PubMed

Insights

Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality (PIM) scoring systems require adjustments for use in Indian pediatric intensive care units (PICUs). Validation showed both models underestimated observed mortality rates.

Area of Science:

  • Pediatric critical care medicine
  • Healthcare outcomes research
  • Clinical informatics

Background:

  • Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality (PIM) are established scoring systems for predicting mortality in pediatric intensive care units (PICUs).
  • Validation of these scoring systems is crucial to ensure their accuracy and applicability in diverse healthcare settings, including low- and middle-income countries.
  • Previous studies have shown variability in the performance of PRISM and PIM across different populations and geographical regions.

Purpose of the Study:

  • To validate the performance of the PRISM and PIM scoring systems in a PICU setting in India.
  • To compare the predictive accuracy of PRISM and PIM against observed mortality rates in a cohort of Indian pediatric patients.
  • To assess the calibration and discrimination of both scoring systems within the study population.

Main Methods:

  • A single-center prospective cohort study was conducted involving 120 pediatric patients admitted to an eight-bed PICU.
  • PRISM and PIM scores were calculated for each patient upon admission.
  • Predicted mortality rates derived from PRISM and PIM were compared with the observed mortality rate.

Main Results:

  • Both PRISM and PIM significantly underestimated the observed mortality rate (21.7%), with predicted rates of 5.68% and 8.84%, respectively.
  • The Pediatric Index of Mortality (PIM) demonstrated slightly better calibration power compared to the Pediatric Risk of Mortality (PRISM).
  • The discriminatory performance of both PRISM and PIM was found to be comparable.

Conclusions:

  • The PRISM and PIM scoring systems require modifications to be accurately validated and applied in the context of Indian PICU settings.
  • Further research is recommended to refine these scoring systems for improved prediction of mortality in this specific population.
  • The findings highlight the need for context-specific validation of established clinical prediction tools in pediatric critical care.

Keywords:
PICUPIMPRISMcritically ill children

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