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Knowing the score: using predictive scoring systems in clinical practice

M B Zollo1, J C Moskop, C E Kahn

  • 1Medical College of Wisconsin, Milwaukee, USA.

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses
|March 1, 1996
PubMed
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The Pediatric Risk of Mortality score offers some clinical decision support but requires careful use. Its limitations, including data variability and exclusion of patient values, necessitate cautious application in pediatric intensive care settings.

Area of Science:

  • Pediatric critical care medicine
  • Clinical decision support systems
  • Biostatistics in healthcare

Background:

  • Outcome scores are increasingly used to aid clinical decisions, particularly in cases of potentially futile care.
  • The Pediatric Risk of Mortality (PRM) score is a tool for assessing mortality risk in pediatric intensive care units (PICUs).

Purpose of the Study:

  • To evaluate the utility of the Pediatric Risk of Mortality score for individual patient care decisions in clinical practice.
  • To identify features of the PRM score that necessitate careful consideration when applied to individual patients.

Main Methods:

  • Analysis of the Pediatric Risk of Mortality score's features relevant to clinical decision-making.
  • Examination of data collection and presentation methods for potential variability and bias.

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  • Assessment of the score's capacity to integrate patient and family values.

    • Main Results:

    • Variability and bias in data collection and presentation were identified as significant limitations.
    • The PRM score does not incorporate patient and family values into its risk assessment.
    • The score provides adjunctive information but requires cautious interpretation.

    Conclusions:

    • The Pediatric Risk of Mortality score can be a useful adjunct but must be used with caution in individual patient care decisions.
    • Clinicians must be aware of the score's limitations, including data issues and the exclusion of patient/family values.
    • Application of PRM scores requires consideration of validation context, individual patient variability, and the paramount importance of patient and caregiver values.