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Published on: January 17, 2025
Evaluation of Severity of Illness Scores in the Pediatric ECMO Population
Venessa L Pinto1, Danielle Guffey2, Laura Loftis1
1Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States.
Insights
Pediatric intensive care unit (ICU) mortality scores like PIM2, PRISM III, and PELOD are not effective for predicting outcomes in children receiving extracorporeal membrane oxygenation (ECMO). These general ICU scores lack validation and association with mortality in the specialized ECMO patient population.
Area of Science:
- Pediatric Critical Care Medicine
- Extracorporeal Membrane Oxygenation
- Healthcare Outcomes Research
Background:
- Pediatric risk prediction scores are crucial for ICU patient management.
- Existing scores like PIM2, PRISM III, and PELOD are validated for general pediatric ICU populations.
- The applicability of these scores to specialized populations, such as pediatric ECMO patients, remains unvalidated.
Purpose of the Study:
- To evaluate the association of three common pediatric intensive care unit (ICU) mortality risk scores with mortality in pediatric patients undergoing extracorporeal membrane oxygenation (ECMO).
- To determine if Pediatric Index of Mortality 2 (PIM2), Pediatric Risk of Mortality Score III (PRISM III), and Pediatric Logistic Organ Dysfunction (PELOD) scores can be reliably used for prognostication in pediatric ECMO.
Main Methods:
- Retrospective cohort study utilizing data from the Pediatric ECMO Outcomes Registry (PEDECOR) between 2014 and 2018.
- Inclusion of pediatric patients (≤18 years) initiated on ECMO.
- Logistic regression and Receiver Operating Characteristics (ROC) curve analysis were employed to assess the predictive accuracy (Area Under the Curve - AUC) of PIM2, PRISM III, and PELOD scores for in-hospital mortality.
Main Results:
- The study analyzed 655 pediatric ECMO cases, with 289 (44.1%) resulting in non-survival to hospital discharge.
- The AUC values for PIM2, PRISM III, and PELOD in predicting mortality were 0.52, 0.52, and 0.51, respectively.
- These low AUC values indicate a lack of significant association between the studied scores and mortality risk in this pediatric ECMO cohort.
Conclusions:
- The PIM2, PRISM III, and PELOD scores demonstrate no significant association with mortality in pediatric patients requiring ECMO.
- These general pediatric ICU risk stratification tools are not suitable for prognostication or risk adjustment in the unique and critically ill pediatric ECMO population.
- Clinical practice should avoid using these scores for decision-making in pediatric ECMO patients due to their lack of predictive validity.
Abstract:
Though commonly used for adjustment of risk, severity of illness and mortality risk prediction scores, based on the first 24 h of intensive care unit (ICU) admission, have not been validated in the pediatric extracorporeal membrane oxygenation (ECMO) population. We aimed to determine the association of Pediatric Index of Mortality 2 (PIM2), Pediatric Risk of Mortality Score III (PRISM III) and Pediatric Logistic Organ Dysfunction (PELOD) scores with mortality in pediatric patients on ECMO. This was a retrospective cohort study of children ≤18 years of age included in the Pediatric ECMO Outcomes Registry (PEDECOR) from 2014 to 2018. Logistic regression and Receiver Operating Characteristics (ROC) curves were used to calculate the area under the curve (AUC) to evaluate association of mortality with the scores. Of the 655 cases, 289 (44.1%) did not survive until hospital discharge. AUCs for PIM2, PRISM III, and PELOD predicting mortality were 0.52, 0.52, and 0.51 respectively. PIM2, PRISM III, and PELOD scores are not associated with odds of mortality for pediatric patients receiving ECMO. These scores for a general pediatric ICU population should not be used for prognostication or risk stratification of a select population such as ECMO patients.
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