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Performance and analysis of four pediatric mortality prediction scores among critically ill children: A multicenter
F Ekinci1, D Yildizdas1, O O Horoz1
1Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey.
Insights
Pediatric Index of Mortality 2 (PIM2) and Pediatric Risk of Mortality (PRISM) scores accurately predicted mortality in Turkish pediatric intensive care units. Newer scores, PIM3 and PRISM4, showed poor calibration in this cohort.
Area of Science:
- Pediatric critical care medicine
- Clinical epidemiology
- Health outcomes research
Background:
- Pediatric mortality scoring systems are crucial for risk stratification in pediatric intensive care units (PICUs).
- Evaluating the performance of existing scoring systems in diverse populations is essential for clinical applicability.
- The Pediatric Index of Mortality 2 (PIM2), PIM3, Pediatric Risk of Mortality (PRISM), and PRISM4 are commonly used pediatric mortality scoring systems.
Purpose of the Study:
- To compare the prognostic performance of PIM2, PIM3, PRISM, and PRISM4 scoring systems.
- To determine the most applicable pediatric mortality score for a Turkish pediatric study cohort.
- To assess both discrimination and calibration of these scoring systems.
Main Methods:
- Prospective observational multicenter cohort study in four tertiary-care PICUs in Turkey.
- Inclusion of children aged 1 month to 16 years admitted between October 2019 and March 2020.
- Assessment of discrimination using area under the receiver operating characteristic curve (AUC) and calibration using the Hosmer-Lemeshow goodness-of-fit (GOF) test.
Main Results:
- A total of 570 patients were enrolled with an observed mortality rate of 8.2%.
- PIM2 and PRISM demonstrated good calibration (PIM2: p=0.28, PRISM: p=0.62).
- PIM3 and PRISM4 showed statistically significant poor calibration (PIM3: p=0.003, PRISM4: p=0.008), despite good discriminatory power (AUCs ranging from 0.917 to 0.934).
Conclusions:
- PIM2 and PRISM scoring systems demonstrated accurate overall performance (discrimination and calibration) in Turkish pediatric patients.
- These systems showed the best fit for risk stratification in the study cohort.
- PIM3 and PRISM4, while having good discriminatory power, exhibited poor calibration in this specific population.
Objective:
We aimed to evaluate and compare the prognostic performance of common pediatric mortality scoring systems (the Pediatric Index of Mortality 2 [PIM2], PIM3, Pediatric Risk of Mortality [PRISM], and PRISM4 scores) to determine which is the most applicable score in our pediatric study cohort.
Methods:
This prospective observational multicenter cohort study was conducted in four tertiary-care pediatric intensive care units (PICUs) in Turkey. All children, between 1 month and 16 years old, admitted to the participating PICUs between October 1, 2019, and March 31, 2020, were included in the study. Discrimination between death and survival was assessed by area under the receiver operating characteristic plot (AUC) for each model. The Hosmer-Lemeshow goodness-of-fit (GOF) test was used to assess the calibration of the models, RESULTS: A total of 570 patients (median age 35 months) were enrolled in the study. The observed mortality rate was 8.2% (47/570). The standardized mortality ratio (SMR) of PIM2, PIM3, PRISM, and PRISM4 with 95% confidence interval (CI) were 0.94 (0.68-1.23), 1.27 (0.93-1.68), 0.86 (0.63-1.13), and 1.5 (1.10-1.97), respectively. The AUC with 95% CI was 0.934 (0.91-0.96) for PIM2, 0.934 (0.91-0.96) for PIM3, 0.917 (0.88-0.95) for PRISM, and 0.926 (0.88-0.97) for PRISM4 models. The Hosmer-Lemeshow test showed that the difference between observed and predicted mortality by PIM3 (p = 0.003) and PRISM4 (p = 0.008) was statistically significant whereas PIM2 (p = 0.28) and PRISM (p = 0.62) showed good calibration.
Conclusion:
The overall performance of (both discrimination and calibration) PRISM and PIM2 scoring systems in Turkish pediatric patients aged 1 month to 16 years was accurate and had the best fit for risk groups according to our study. Although PIM3 and PRISM4 have good discriminatory power, their calibration was very poor in our study cohort.
