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Performance of Pediatric Risk of Mortality III and Pediatric Index of Mortality III Scores in Tertiary Pediatric
Ahmed S Alkhalifah1, Abdulaziz AlSoqati2, Jihad Zahraa2
1Qatif Central Hospital, Al-Qatif, Saudi Arabia.
Insights
The Pediatric Risk of Mortality III (PRISM III) and Pediatric Index of Mortality III (PIM III) showed good discrimination but poor calibration in Saudi Arabia. Further testing or local model development is recommended for accurate pediatric intensive care unit performance assessment.
Area of Science:
- Pediatric critical care medicine
- Healthcare quality assessment
- Biostatistics in healthcare
Background:
- Pediatric Risk of Mortality III (PRISM III) and Pediatric Index of Mortality III (PIM III) are widely used to assess outcomes in pediatric intensive care units (PICUs).
- Evaluating the performance of these scoring systems in diverse healthcare settings, such as Saudi Arabia, is crucial for their appropriate application.
Purpose of the Study:
- To evaluate the performance of PRISM III and PIM III in predicting mortality within a tertiary PICU in Saudi Arabia.
- To identify factors influencing the accuracy and calibration of these pediatric scoring systems.
Main Methods:
- A retrospective, single-center study was conducted at King Fahad Medical City PICU, Saudi Arabia.
- Data from pediatric patients (<14 years) admitted between January 2015 and December 2019 were analyzed.
- Performance was assessed by comparing predicted versus observed mortality, considering age, disease category, and resuscitation status.
Main Results:
- Both PRISM III and PIM III demonstrated significant differences between predicted and observed mortality, indicating poor calibration.
- Excluding do-not-resuscitate (DNR) patients improved the discrimination of both indices.
- Performance varied by age group (worst in infants <12 months) and disease category, with better results for metabolic/genetic and CNS illnesses.
Conclusions:
- While PRISM III and PIM III possess sufficient discrimination ability, their calibration is inadequate for this Saudi Arabian PICU population.
- Further validation in different PICU settings or development of locally adapted models is necessary for reliable performance assessment and planning.
Objective:
To assess the performance of the Pediatric Risk of Mortality III (PRISM III) and Pediatric Index of Mortality III (PIM III) indices in a tertiary pediatric intensive care unit (PICU) in Saudi Arabia and to identify the factors affecting the observed performance.
Design:
Retrospective, single-center study using data collected from the Virtual Pediatric Systems web-based database.
Setting:
King Fahad Medical City PICU, Saudi Arabia.
Patients:
All pediatric patients <14 years of age admitted between 1 January 2015, and 31 December 2019.
Interventions:
Comparison of PRISM III and PIM III performances in predicting mortality across different age groups, disease categories, and resuscitation decision statuses.
Measurements:
Normality of distribution was assessed using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Patient characteristics were compared between survivors and non-survivors. The medians and ranges were calculated for continuous data, whereas frequencies and percentages were used for nominal data. The Mann-Whitney U test, Kruskal-Wallis test, and Chi-square test were used to compare the characteristics of survivors and non-survivors.
Main Results:
There was a significant difference between the predicted mortality and observed mortality in both the PRISM III and PIM III. Better discrimination was found after excluding do-not-resuscitate (DNR) patients. The worst calibration and discrimination were recorded for infants <12 months of age. The PRISM III performed significantly better in patients with metabolic/genetic and central nervous system illnesses. Non-DNR patients had a lower standardized mortality rate using the PRISM III and PIM III. The PRISM III and PIM III indices performed better in patients who died within the first week of admission.
Conclusion:
These models had sufficient discrimination ability and poor calibration. Since they were designed for particular patient characteristics and PICUs, further testing in different environments is necessary before utilization for planning and assessing performance. Alternatively, new models could be developed which are suitable for local PICUs.
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