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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.
Insights
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.
- 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.
Abstract:
Outcome scores have been promoted as adjuncts to clinical decision making, especially when further care is thought to be futile. The Pediatric Risk of Mortality score is used to calculate the risk of mortality for patients admitted to pediatric intensive care units. In this article the Pediatric Risk of Mortality score in evaluated for its ability to contribute to individual patient care decisions in the context of clinical practice. Through analysis several features of the Pediatric Risk of Mortality score were identified that require discretion if the score is to be used in decisions involving individual patients. These features include variability and bias introduced in data collection and data presentation. Also, outcome scores do not allow for the incorporation of patient and family values into the decision process. Outcome scores can provide some adjunctive information to clinicians, but they should be used with caution when making patient care decisions. Use of Pediatric Risk of Mortality scores in clinical practice must be tempered with a knowledge of the limitations of the scores, individual patient variability, the conditions under which the scores have been validated and collected and, most importantly, an awareness that outcome scores do not take into account the caregiver and patient values that are inherent in any treatment decision.