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The Various Scoring Systems in Pediatric Intensive Care Units: A Prospective Observational Study
Jyotsna1, Rakesh Kumar1, Shambhavi Sharan1
1Pediatrics, Indira Gandhi Institute of Medical Sciences, Patna, IND.
Insights
In India, pediatric scoring systems like PRISM 4 and PIM 3 may not accurately predict outcomes in critically ill children. The study found pediatric Sequential Organ Failure Assessment (pSOFA) and pediatric Logistic Organ Dysfunction (PELOD) 2 scores to be reliable predictors of mortality.
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.
Background:
The discrimination power of the pediatric risk of mortality (PRISM), pediatric index of mortality (PIM), sequential organ failure assessment (SOFA), and pediatric logistic organ dysfunction (PELOD) may not always be true for countries such as India due to differences in factors from those nations where these scoring systems were validated. Therefore, this study was undertaken to determine and compare severity, course of illness, and outcomes in critically ill children admitted to the pediatric intensive care unit (PICU) using different scoring systems such as PRISM 4, PIM 3, PELOD 2, and the pediatric sequential organ failure assessment (pSOFA ) score, and to analyze the clinical spectrum and demographic profile of children admitted to the PICU.
Materials And Method:
This was a prospective, single-center, observational study conducted in the PICU of the Indira Gandhi Institute of Medical Science, Patna, India, over two years. Two hundred children in the age group of one month to 14 years admitted to the PICU were recruited into the study. Prognostic scoring systems, including PRISM4 and PIM3, were used to compare the outcome, mortality, and length of PICU stay, whereas PELODS and pSOFA were descriptive scores that assessed the multiorgan dysfunction. A correlation between the different scoring systems and the outcome was determined.
Results:
The majority of children (26.5%, n=53) were one to three years of age. The maximum number of patients was male (66.5%, n=133). Renal complications were the predominant admission diagnosis in 19% (n=38) of children. The mortality rate was found to be 18.5%. The mortality was most common in infants <1 year of age (n=11, 29.73%) and those of the male sex (n=22, 59.46%). A significant correlation was found between length of stay and mortality (p<0.00001). A significant positive correlation was observed between mortality and PRISM 4, PIM 3, PELOD 2, and pSOFA scores on the first day of admission (p<0.00001). The pSOFA and PELOD2 showed better discrimination power (area under the curve (AUC): 0.77 and 0.74, respectively).
Conclusion:
The study concluded that the pSOFA and PELOD2 scores are reliable predictors of mortality in critically ill children.
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