Related Experiment Video
Updated: Sep 18, 2025
Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Comparative Performance of Pediatric Risk of Mortality IV and Pediatric Index of Mortality 3 in Critically Ill
Kushal R Kalvit1, Shilpushp J Bhosale2, Jacob G Pulinilkunnathi3
1Guys and St Thomas' NHS Foundation Trust, London, United Kingdom.
Insights
Pediatric Risk of Mortality IV and Pediatric Index of Mortality 3 scores showed acceptable discrimination in critically ill children with cancer. PRISM IV demonstrated better calibration for predicting survival in this vulnerable oncology population.
Area of Science:
- Pediatric Critical Care
- Oncology
- Medical Scoring Systems
Background:
- Pediatric Risk of Mortality (PRISM) IV and Pediatric Index of Mortality (PIM) 3 are widely used severity of illness scoring systems.
- These systems lack validation in critically ill pediatric oncology patients.
Purpose of the Study:
- To compare the performance of PRISM IV and PIM 3 in critically ill children with cancer.
- To assess the discriminative ability and calibration of these scores in predicting mortality.
Main Methods:
- A prospective observational study included 415 critically ill pediatric patients.
- Demographic, physiological, and laboratory data were collected to calculate PRISM IV and PIM 3 scores.
- Online calculators were used to determine scores and predicted mortality risk.
Main Results:
- Hospital mortality was 36.1%.
- Area Under the Receiver Operating Characteristic curve (AUROC) for PRISM IV was 0.71, and for PIM 3 was 0.78.
- PRISM IV showed good calibration, while PIM 3 calibration suggested potential issues.
Conclusions:
- Both PRISM IV and PIM 3 demonstrated acceptable discrimination for critically ill pediatric oncology patients.
- PRISM IV exhibited superior calibration in predicting survival within this cohort.
Background And Aims:
In pediatric critical care, pediatric risk of mortality (PRISM) and pediatric index of mortality (PIM) scoring systems are the most widely used severity of illness scoring systems. The current versions of these scoring systems (PRISM IV and PIM 3) have not been validated in critically ill oncology patients. The aim of this study was to evaluate the comparative performance of PRISM IV and PIM 3 in critically ill children with cancer.
Patients And Methods:
About 415 critically ill pediatric patients were recruited at a single-center, mixed medical-surgical ICU in a prospective observational study. Patients with an expected ICU stay of greater than 24 h were included. Demographic, physiological, and laboratory parameters required to calculate the PRISM IV and PIM 3 scores were collected; laboratory data from 2 hours prior to 4 hours after admission, and physiological data within 4 hours of admission were collected. The worst value was considered for calculating the scores. Both scores and their predicted mortality risk were calculated using online calculators.
Results:
The mortality at ICU discharge and at hospital discharge was 32.7% and 36.1%, respectively. For the prediction of hospital mortality, the AUROC for PRISM IV score was 0.71and the PIM 3 estimated mortality (%) was 0.78, respectively. There was a statistically significant positive correlation between the PRISM IV score and PIM 3 estimated mortality (%) with the hospital mortality. The logistic model for PRISM IV score also passed the goodness-of-fit test indicating a good model fit. The goodness-of-fit test for the PIM 3 model suggests that the model may not fit the data well and may require further investigation or improvement.
Conclusions:
Both PRISM IV and PIM 3 scores showed acceptable discriminative ability between survivors and non-survivors in the critically ill pediatric oncology population. However, only the PRISM IV score showed good calibration in the prediction of survival.
How To Cite This Article:
Kalvit KR, Bhosale SJ, Pulinilkunnathi JG, Vijayakumaran SC, Shrivastava AM, Kulkarni AP. Comparative Performance of Pediatric Risk of Mortality IV and Pediatric Index of Mortality 3 in Critically Ill Children with Cancer: A Prospective Observational Study. Indian J Crit Care Med 2025;29(6):486-491.
Related Concept Videos
01:21Cancer Survival Analysis
01:20Comparing the Survival Analysis of Two or More Groups
01:12Relative Risk
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:30Acute Respiratory Failure-III