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Differences in pediatric ICU mortality risk over time

J M Tilford1, P K Roberson, S Lensing

  • 1Department of Pediatrics, University of Arkansas for Medical Sciences, and Arkansas Children's Hospital, Little Rock 72202-3591, USA. TilfordMickJ@exchange.uams.edu

Critical Care Medicine
|October 22, 1998
PubMed
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Pediatric intensive care unit (ICU) mortality risk has significantly decreased over time, with a 15% overall reduction. This improvement impacts the accuracy of the original Pediatric Risk of Mortality (PRISM) score for quality assessment.

Area of Science:

  • Pediatric Critical Care Medicine
  • Health Services Research
  • Biostatistics

Background:

  • Pediatric intensive care unit (ICU) mortality risk assessment is crucial for quality evaluation.
  • The Pediatric Risk of Mortality (PRISM) score is a widely used tool for predicting mortality in pediatric ICUs.
  • Changes in healthcare quality and medical advancements can alter baseline mortality risks over time.

Purpose of the Study:

  • To compare pediatric ICU mortality risk between two distinct time periods.
  • To evaluate the implications of changing mortality risk on the performance of severity-of-illness systems like PRISM.
  • To assess the impact of evolving mortality trends on quality-of-care evaluations in pediatric ICUs.

Main Methods:

  • Prospective data collection from 10,833 consecutive admissions across 16 US pediatric ICUs (1993 data).

Related Experiment Videos

  • Utilized original PRISM coefficients (1980-1985) to calculate mortality probabilities in the contemporary dataset.
  • Calculated updated mortality probabilities using logistic regression with original PRISM variables and assessed quality using standardized mortality ratios.

    • Main Results:

    • A significant overall reduction in pediatric ICU mortality risk by 15% (p < .001) was observed.
    • Marked improvements in mortality risk were noted for infants (<1 mo: 39% reduction; 1-12 mos: 28% reduction).
    • Substantial risk reduction for respiratory diseases (45% improvement) deteriorated the calibration of the original PRISM score, leading to disparities in quality assessment.

    Conclusions:

    • Observed changes in pediatric ICU mortality risk reflect general improvements in the quality of pediatric intensive care.
    • The widespread use of the original PRISM score is now limited due to recent advancements in pediatric ICU care.
    • The original PRISM score's utility for quality-of-care assessment has been negated by improved outcomes, necessitating updated or alternative systems.