The Various Scoring Systems in Pediatric Intensive Care Units: A Prospective Observational Study.

Area of Science:

• Pediatric Intensive Care
• Critical Care Medicine
• Epidemiology

Background:

• Established pediatric scoring systems (PRISM, PIM, SOFA, PELOD) may have limited applicability in diverse healthcare settings like India.
• Validation of these scores is crucial due to potential differences in patient populations and disease factors.
• This study addresses the need to evaluate existing scoring systems in the Indian context.

Purpose of the Study:

• To compare the performance of PRISM 4, PIM 3, PELOD 2, and pSOFA scores in predicting outcomes for critically ill children in India.
• To analyze the clinical spectrum and demographic profile of children admitted to a pediatric intensive care unit (PICU).
• To determine the correlation between different scoring systems and patient outcomes, including mortality and length of stay.

Main Methods:

• A prospective, single-center observational study was conducted over two years in a PICU in Patna, India.
• Two hundred children aged one month to 14 years were recruited.
• PRISM 4 and PIM 3 were used for outcome and mortality prediction, while PELOD 2 and pSOFA assessed organ dysfunction; correlations with outcomes were analyzed.

Main Results:

• The study included 200 children, with the majority being male (66.5%) and aged 1-3 years (26.5%).
• Renal complications were the most common admission diagnosis (19%). The overall mortality rate was 18.5%, highest in infants <1 year and males.
• A significant positive correlation was found between mortality and PRISM 4, PIM 3, PELOD 2, and pSOFA scores on admission (p<0.00001). pSOFA (AUC: 0.77) and PELOD2 (AUC: 0.74) demonstrated superior discrimination power.

Conclusions:

• Pediatric Sequential Organ Failure Assessment (pSOFA) and pediatric Logistic Organ Dysfunction (PELOD) 2 scores are reliable predictors of mortality in critically ill Indian children.
• These scores offer better discrimination power compared to PRISM 4 and PIM 3 in this population.
• The findings support the use of pSOFA and PELOD2 for risk stratification and outcome prediction in Indian PICUs.