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Performance of the PRISM I, PIM2, PELOD-2 and PRISM IV scoring systems in western China: a multicenter prospective
Xue-Peng Zhang1,2,3, Yun-Xia Feng4, Yang Li2
1Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China.
Insights
The Pediatric Risk of Mortality Score IV (PRISM IV) demonstrated the best performance in predicting mortality in pediatric intensive care units (PICUs) in western China. Further validation in neonatal intensive care units (NICUs) is recommended.
Area of Science:
- Pediatric critical care medicine
- Health outcomes research
- Medical scoring systems
Background:
- Predicting mortality in Pediatric Intensive Care Units (PICUs) is crucial for patient management and resource allocation.
- Existing scoring systems require evaluation for their effectiveness in diverse populations and settings.
- Western China's PICUs present a specific context for assessing these tools.
Purpose of the Study:
- To evaluate and compare the performance of four established scoring systems in predicting mortality within PICUs in western China.
- To determine which scoring system offers the most accurate and reliable mortality prediction in this specific region.
- To provide evidence-based recommendations for the optimal use of these tools in clinical practice.
Main Methods:
- A multicenter, prospective cohort study involving 2034 patients across six PICUs in western China.
- Performance evaluation of Pediatric Risk of Mortality Score (PRISM) I, Pediatric Index of Mortality 2 (PIM2), Pediatric Logistic Organ Dysfunction Score-2 (PELOD-2), and PRISM IV.
- Assessment of discrimination using Area Under the Receiver Operating Characteristic Curve (AUC) and calibration using the Hosmer-Lemeshow goodness-of-fit test.
Main Results:
- PRISM IV exhibited the highest discrimination with an AUC of 0.91 (95% CI 0.88-0.94).
- PRISM I (AUC 0.88) and PIM2 (AUC 0.84) also showed good predictive performance.
- PELOD-2 demonstrated lower performance (AUC 0.80) and poorer calibration (P < 0.001).
- PRISM IV and PIM2 showed acceptable calibration, while PRISM I and PELOD-2 had less favorable calibration.
Conclusions:
- PRISM IV is the most effective scoring tool for predicting mortality in PICUs in western China.
- PRISM I and PIM2 are also viable options, though PRISM IV shows superior performance.
- Further validation of PRISM IV in Neonatal Intensive Care Units (NICUs) is warranted to assess its broader applicability.
Background:
The aim of this study was to evaluate the performance of the four scoring tools in predicting mortality in pediatric intensive care units (PICUs) in western China.
Methods:
This was a multicenter, prospective, cohort study conducted in six PICUs in western China. The performances of the scoring systems were evaluated based on both discrimination and calibration. Discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUC) for each model. Calibration was measured across defined groups based on mortality risk using the Hosmer-Lemeshow goodness-of-fit test.
Results:
A total of 2034 patients were included in this study, of whom 127 (6.2%) died. For the entire cohort, AUCs for Pediatric Risk of Mortality Score (PRISM) I, Pediatric Index of Mortality 2 (PIM2), Pediatric Logistic Organ Dysfunction Score-2 (PELOD-2) and PRISM IV were 0.88 [95% confidence interval (CI) 0.85-0.92], 0.84 (95% CI 0.80-0.88), 0.80 (95% CI 0.75-0.85), and 0.91 (95% CI 0.88-0.94), respectively. The Hosmer-Lemeshow goodness-of-fit Chi-square value was 12.71 (P = 0.12) for PRISM I, 4.70 (P = 0.79) for PIM2, 205.98 (P < 0.001) for PELOD-2, and 7.50 (P = 0.48) for PRISM IV [degree of freedom (df) = 8]. The standardized mortality ratios obtained with the PRISM I, PIM2, PELOD-2, and PRISM IV models were 0.87 (95% CI, 0.75-1.01), 0.97 (95% CI, 0.85-1.12), 1.74 (95% CI, 1.58-1.92), and 1.05 (95% CI, 0.92-1.21), respectively.
Conclusions:
PRISM IV performed best and can be used as a prediction tool in PICUs in Western China. However, PRISM IV needs to be further validated in NICUs.
