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Application of Pediatric Risk of Mortality (PRISM) III Score in Predicting Mortality Outcomes
Prakash Joshi1, Sumit Agrawal1, Jagat Jeevan Ghimire1
1Department of Pediatric Medicine, Kanti Childrens Hospital, Maharajgunj, Kathmandu, Nepal.
Insights
The Pediatric Risk of Mortality III score effectively predicts mortality in children admitted to the pediatric intensive care unit. This risk score is a valuable tool for assessing patient outcomes and guiding clinical decisions.
Area of Science:
- Pediatric critical care medicine
- Clinical epidemiology
- Biostatistics
Background:
- Children in pediatric intensive care units (PICUs) face a high risk of mortality.
- The Pediatric Risk of Mortality III (PRISM III) score is increasingly used to predict mortality within 24 hours of PICU admission.
Purpose of the Study:
- To evaluate the validity of the Pediatric Risk of Mortality III score in predicting mortality among patients admitted to a PICU.
Main Methods:
- A prospective observational study was conducted in a government pediatric hospital's PICU from January to June 2021.
- Patients aged 1 month to 14 years were enrolled, and their PRISM III scores were calculated within 24 hours of admission.
- Statistical analyses included Chi-square tests and logistic regression to assess predictor associations and score validity.
Main Results:
- The mean PRISM III score was significantly lower in survivors (4.67 ± 3.8) compared to non-survivors (14.10 ± 6.07; p<0.001).
- Inotropic and ventilator support were associated with significantly higher mortality rates (49.4% vs 0.6% and 81.8% vs 1.5%, respectively; p<0.001).
- Key significant risk factors included low systolic blood pressure, abnormal pupillary reflex, elevated blood urea nitrogen, and decreased platelets (p<0.001). The AUC was 0.916±0.024 (p<0.001).
Conclusions:
- The Pediatric Risk of Mortality III score is a valid and useful prognostic tool for predicting mortality in pediatric intensive care unit patients.
Background:
Children admitted in a pediatric intensive care unit have a high risk of mortality. Pediatric risk of mortality III score in first 24 hours of admission has increasingly been used to predict mortality. The objective of this study was to evaluate the validity of Pediatric risk of mortality score in prediction of mortality among the patient admitted in pediatric intensive care unit.
Methods:
This prospective observational study was conducted at pediatric intensive care unit of a government pediatric hospital from January to June 2021. Patients between 1 month to 14 years of age and meeting the inclusion criteria were enrolled. Pediatric risk of mortality III score was calculated within 24 hours of admission. Patients were followed up for outcome measure as survivors and non survivors. Chi square test and logistic regression analysis were used to find the association of predictors and the score.
Results:
The mean Pediatric risk of mortality III score was lower in survivors than in non-survivors (4.67 ± 3.8 versus 14.10 ± 6.07; p<0.001). Those requiring inotropic and ventilator support have significantly higher mortality [49.4 versus 0.6 (p<0.001) and 81.8 versus 1.5 (p<0.001) respectively]. Minimum systolic blood pressure, abnormal pupillary reflex, increased blood urea nitrogen and decreased platelet were the significant (p<0.001) risk factors. The area under the Receiver Operating Characteristic curve was 0.916±0.024 (p<0.001) and goodness-of-fit test showed no significant difference between observed and expected mortalities (p=0.186).
Conclusions:
The Pediatric risk of mortality score constitutes a useful prognostic tool in predicting the mortality.
Key Words:
Mortality; pediatrics; pediatric intensive care unit; risk score.
