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Use of a Mortality Prediction Model in Children on Mechanical Ventilation: A 5-Year Experience in a Tertiary
Waleed H Albuali1, Amal A Algamdi2, Elham A Hasan1
1Department of Pediatrics, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Insights
A new Simple Early Predictive Mortality (SEPM) model shows high specificity in predicting deaths in pediatric intensive care units (PICUs). This model is comparable to the PRISM III score for identifying children who may benefit from mechanical ventilation.
Area of Science:
- Pediatric critical care medicine
- Mortality prediction models
- Mechanical ventilation in children
Background:
- Existing scoring systems for predicting mortality in severely ill children in the pediatric intensive care unit (PICU) are established.
- Despite high-quality care, children in the PICU can develop complications leading to rapid health deterioration and death.
- There is a need for a simple, highly specific model to identify children at high risk of mortality who might benefit from extensive mechanical ventilation.
Purpose of the Study:
- To establish a Simple Early Predictive Mortality (SEPM) model with high specificity.
- To identify severely ill children in the PICU who could benefit from extensive mechanical ventilation.
- To provide a simple, early mortality prediction tool for pediatric intensive care.
Main Methods:
- Retrospective longitudinal study design.
- Inclusion of pediatric patients (older than two weeks) on mechanical ventilation admitted to the PICU from January 2015 to December 2019.
- Analysis of mortality causes and comparison of the SEPM model with the Pediatric Risk of Mortality (PRISM) III score.
Main Results:
- The study included 400 pediatric patients; the mortality rate for children on mechanical ventilation was 28.90%.
- Primary causes of death included respiratory (31%), cardiovascular (19%), and neurological (17%) issues.
- The SEPM model demonstrated high specificity (97.31%) and accuracy (92.5%), comparable to the PRISM III score (98.51% specificity, 95.25% accuracy).
Conclusions:
- The SEPM model exhibits high specificity for mortality prediction in severely ill children.
- The SEPM model, utilizing six easily obtainable clinical predictors, shows comparable predictive ability to the PRISM III score.
- Further validation of the SEPM model in diverse settings and prospective studies are recommended.
Purpose:
Currently, several scoring systems for predicting mortality in severely ill children who require treatment in a pediatric intensive care unit (PICU) have been established. However, despite providing high-quality care, children might develop complications that can cause rapid deterioration in health status and can lead to death. Hence, this study aimed to establish a simple early predictive mortality (SEPM) model with high specificity in identifying severely ill children who would possibly benefit from extensive mechanical ventilation during PICU admission.
Patients And Methods:
This is a retrospective longitudinal study that included pediatric patients aged older than two weeks who were on mechanical ventilation and were admitted to the PICU of King Fahd Hospital of the University from January 2015 to December 2019.
Results:
In total, 400 pediatric patients were included in this study. The mortality rate of children on mechanical ventilation was 28.90%, and most deaths were associated with respiratory (n = 124 [31%]), cardiovascular (n = 76 [19%]), and neurological (n = 68 [17%]) causes. The SEPM model was reported to be effective in predicting mortality, with an accuracy, specificity, and sensitivity of 92.5%, 97.31%, and 66.15%, respectively. Moreover, the accuracy, specificity, and sensitivity of the Pediatric Risk of Mortality (PRISM) III score in predicting mortality was 95.25%, 98.51%, and 78.46%, respectively.
Conclusion:
The SEPM model had a high specificity for mortality prediction. In this model, only six clinical predictors were used, which might be easily obtained in the early period of PICU admission. The ability of the SEPM model and the PRISM III score in predicting mortality in severely ill children was comparable. However, the accuracy of the newly established model in other settings should be validated, and a prospective longitudinal study that considers the effect of the treatment on the model's predictive ability must be conducted.
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