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Related Experiment Videos

Decision support issues using a physiology based score

J P Marcin1, M M Pollack, K M Patel

  • 1George Washington University School of Medicine, Department of Critical Care Medicine, Children's National Medical Center, Washington, DC 20010-2970, USA.

Intensive Care Medicine
|January 14, 1999
PubMed
Summary
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Pediatric Risk of Mortality III (PRISM III) scores offer valuable insights for individual patient survival predictions and resource allocation. However, high-risk patient predictions lack precision due to wide confidence intervals, impacting clinical decision-making.

Area of Science:

  • Pediatric critical care medicine
  • Clinical epidemiology
  • Biostatistics

Background:

  • Physiology-based mortality risk assessments are increasingly accurate.
  • Evaluating the statistical performance and clinical context of prediction models is crucial before implementation.
  • Pediatric Risk of Mortality III (PRISM III) is a widely used scoring system.

Purpose of the Study:

  • To examine confidence intervals and confidence levels in PRISM III predictions.
  • To assess PRISM III's utility in individual patient survival prediction.
  • To evaluate PRISM III's application in resource rationing decisions.

Main Methods:

  • A non-concurrent cohort study.
  • Involved 10,608 consecutive patients from 32 pediatric intensive care units (PICUs).

Related Experiment Videos

  • Analyzed PRISM III scores, observed survival rates, and confidence intervals/levels.

    • Main Results:

    • For individual patients, high PRISM III scores (>28, >35, >42) showed low observed survival rates (6.3%, 5.3%, 0%) with wide 95% upper confidence interval bounds (10.5%, 13.0%, 13.3%).
    • Changing confidence levels significantly altered survival ranges for individual high-risk patients (over 300% change).
    • Resource rationing decisions demonstrated low maximum error rates (e.g., 29/100,000 at 95% certainty), with minimal impact from confidence level changes.

    Conclusions:

    • PRISM III predictions for individual high-risk patients are statistically imprecise due to small group sizes and wide confidence intervals.
    • Confidence levels substantially impact outcome ranges for individual patients, affecting the score's utility.
    • Sample sizes are adequate for resource rationing decisions, but physician and family consensus on "adequate certainty" is needed for widespread acceptance of decision support.