Related Experiment Video
Updated: Jan 18, 2026
Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Paediatric scoring systems in congenital heart surgery: evaluating predictive accuracy for major adverse events
Seyma Sayit Akyar1, Nurgul Yurtseven2, Ozgecan Pırıl Zanbak Mutlu1
1Department of Anesthesiology and Reanimation, Bahcelievler State Hospital, Istanbul, Turkey.
Insights
The Paediatric Logistic Organ Dysfunction score is the most accurate predictor of major adverse events in children after congenital heart surgery, outperforming other common scoring systems. This finding aids in better risk stratification for these vulnerable patients.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery outcomes
- Healthcare risk assessment
Background:
- Congenital heart surgery in pediatric patients carries significant risks.
- Accurate prediction of major adverse events (MAEs) is crucial for optimizing patient care and outcomes.
- Existing scoring systems like PRISM-III, PIM-II, and PELOD have varying degrees of accuracy in this population.
Purpose of the Study:
- To prospectively evaluate and compare the predictive accuracy of three common scoring systems: Pediatric Risk of Mortality-III (PRISM-III), Pediatric Index of Mortality-II (PIM-II), and Pediatric Logistic Organ Dysfunction (PELOD) score.
- To determine which scoring system best predicts major adverse events following congenital heart surgery in pediatric intensive care unit (ICU) patients.
Main Methods:
- A prospective observational study involving 116 pediatric patients (<18 years) requiring ICU admission for ≥24 hours post-congenital heart surgery.
- Major adverse events were defined as a composite outcome including 30-day mortality, ICU readmission, reintubation, neurologic events, ECMO, cardiac arrest, pacemaker need, AKI, or reoperation.
- Predictive accuracy was assessed using logistic regression, area under the receiver operating characteristic curve (AUC), and calibration (Hosmer-Lemeshow test).
Main Results:
- Major adverse events occurred in 29.3% of the 116 included patients.
- All three scoring systems (PRISM-III, PIM-II, PELOD) showed significantly higher scores in patients experiencing MAEs (p<0.001 for all).
- The PELOD score demonstrated the highest discrimination capacity (AUC=0.83), outperforming PRISM-III (AUC=0.70) and PIM-II (AUC=0.77), with good calibration for all scores.
Conclusions:
- The Pediatric Logistic Organ Dysfunction (PELOD) score is superior to the Pediatric Index of Mortality-II (PIM-II) and Pediatric Risk of Mortality-III (PRISM-III) scores in predicting major adverse events in pediatric patients after congenital heart surgery.
- PELOD score offers improved risk stratification for this high-risk surgical population.
- These findings support the use of the PELOD score for enhanced clinical decision-making and resource allocation in pediatric cardiac intensive care.
Objectives:
This study aimed to evaluate the predictive accuracy of Paediatric Risk of Mortality-III, Paediatric Index of Mortality-II, and Paediatric Logistic Organ Dysfunction scoring systems for major adverse events following congenital heart surgery.
Methods:
This prospective observational study included patients under 18 years of age who were admitted to the ICU for at least 24 hours postoperatively following congenital heart surgery. Major adverse events were defined as a composite of 30-day mortality, ICU readmission, reintubation, acute neurologic events, requirement for extracorporeal membrane oxygenation, cardiac arrest requiring cardiopulmonary resuscitation, need for a permanent pacemaker, acute kidney injury, or unplanned reoperation.
Results:
A total of 116 patients, with a median age of 17.5 months (interquartile range: 5.4-60.0) were included in the study. Major adverse events occurred in 34 patients (29.3%). Paediatric Risk of Mortality-III (11.5 [8.0-18.8] vs. 7.0 [2.3-11.0]; p = 0.001), Paediatric Index of Mortality-II (3.8 [2.8-6.6] vs. 2.2 [1.7-2.8]; p < 0.001), and Paediatric Logistic Organ Dysfunction (12.0 [10.0-21.0] vs. 1.0 [1.0-10.0]; p < 0.001) scores were significantly higher in patients with major adverse events than in those without. The Paediatric Logistic Organ Dysfunction score (area under the curve 0.83; 95% confidence interval: 0.74-0.92) demonstrated the highest discrimination capacity compared to Paediatric Risk of Mortality-III (area under the curve 0.70; 95% confidence interval: 0.60-0.81) and Paediatric Index of Mortality-II (area under the curve 0.77; 95% confidence interval: 0.66-0.88) with good calibration (Hosmer-Lemeshow p > 0.05 for all). Based on the logistic regression model evaluation metrics, Paediatric Logistic Organ Dysfunction demonstrated better performance in predicting major adverse events compared with Paediatric Risk of Mortality-III and Paediatric Index of Mortality-II.
Conclusions:
The Paediatric Logistic Organ Dysfunction score outperformed the Paediatric Index of Mortality-II and Paediatric Risk of Mortality-III scores in predicting major adverse events in paediatric patients admitted to the ICU after congenital heart surgery.
