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Comparison of pSOFA with PRISM III and PIM 2 as Predictors of Outcome in a Tertiary Care Pediatric ICU: A Prospective
Shipra Agrwal1, Romit Saxena2, Mridna Jha2
1Department of Pediatrics, ESIC Medical College and Hospital, Faridabad, Haryana, India.
Insights
The pediatric sequential organ failure assessment (pSOFA) score better predicts pediatric intensive care unit (PICU) mortality than PRISM III and PIM 2 scores. This finding aids in predicting outcomes for critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Outcomes Research
- Scoring System Validation
Background:
- Pediatric intensive care unit (PICU) admission necessitates accurate outcome prediction using validated severity scores.
- The pediatric sequential organ failure assessment (pSOFA) score is a descriptive tool with potential for predicting outcomes in critically ill children.
- Existing scores like PRISM III and PIM 2 are well-established but require comparison with newer metrics like pSOFA.
Purpose of the Study:
- To compare the predictive accuracy of the pSOFA score against established scores (PRISM III and PIM 2) for mortality in a pediatric intensive care unit.
- To evaluate the utility of pSOFA in predicting hospital mortality and secondary outcomes such as PICU length of stay, mechanical ventilation need, and acute kidney injury.
- To determine the optimal timing for pSOFA score calculation for the best predictive performance.
Main Methods:
- A prospective, cross-sectional study enrolling 151 children aged 1 month to 12 years in a tertiary care hospital's PICU.
- Pediatric index of mortality (PIM 2) calculated within 1 hour; Pediatric risk of mortality (PRISM) III and pSOFA scores calculated within 24 hours of admission.
- pSOFA score was recalculated at 72 hours; primary outcome was hospital mortality, secondary outcomes included PICU stay duration, mechanical ventilation, and acute kidney injury.
Main Results:
- 151 children were enrolled, with 57.6% requiring mechanical ventilation and a 28-day mortality rate of 21.2%.
- The pSOFA score, particularly when calculated at 72 hours (pSOFA 72), demonstrated the highest area under the ROC curve (0.833 sensitivity, 0.769 specificity at a cut-off of 6.5).
- Predicted mortality medians were 3.4% (IQR 1.5-11%) for PRISM III and 8.2% (IQR 3.1-16.6%) for PIM 2.
Conclusions:
- The pSOFA score, assessed at admission and 72 hours, exhibited superior predictive capability for PICU mortality compared to PRISM III and PIM 2.
- The findings suggest pSOFA is a valuable tool for outcome prediction in critically ill pediatric patients.
- Further research may explore the integration of pSOFA into routine PICU management protocols for enhanced patient care.
Aims And Background:
Severity scores are used to predict the outcome of children admitted to the intensive care unit. A descriptive score such as the pediatric sequential organ failure assessment (pSOFA) may be useful for prediction of outcome. This study was planned to compare the pSOFA score with these well-studied scores for prediction of mortality.
Materials And Methods:
This prospective cross-sectional study was conducted at the pediatric intensive care units (PICU) of a tertiary care hospital. Children aged from 1 month to 12 years were enrolled sequentially. The pediatric index of mortality (PIM 2) score was calculated within 1 hour, and pediatric risk of mortality (PRISM) III and pSOFA scores were calculated within 24 hours of PICU admission. The pediatric sequential organ failure assessment score was recalculated after 72 hours. The primary outcome variable was hospital mortality, and secondary outcome variables were duration of PICU stay, need for mechanical ventilation, and occurrence of acute kidney injury (AKI). Appropriate statistical tests were used.
Results:
About 151 children with median (IQR) age of 36 (6, 84) months were enrolled. Mechanical ventilation was required in 87 (57.6%) children. Mortality was 21.2% at 28 days. The median (IQR) predicted mortality using PRISM III and PIM 2 score were 3.4 (1.5%, 11%) and 8.2 (3.1%, 16.6%) respectively. Area under ROC for prediction of mortality was highest for pSOFA 72 with a cut-off of 6.5 having sensitivity of 83.3% and specificity of 76.9%.
Conclusion:
The pSOFA score calculated at admission and at 72 hours had a better predictive ability for the PICU mortality compared to PRISM III and PIM 2 score.
How To Cite This Article:
Agrwal S, Saxena R, Jha M, Jhamb U, Pallavi. Comparison of pSOFA with PRISM III and PIM 2 as Predictors of Outcome in a Tertiary Care Pediatric ICU: A Prospective Cross-sectional Study. Indian J Crit Care Med 2024;28(8):796-801.
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