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Performance and analysis of four pediatric mortality prediction scores among critically ill children: A multicenter prospective observational study in four PICUs - 24/07/22

Doi : 10.1016/j.arcped.2022.05.001 
F. Ekinci a, , D. Yildizdas a, O.O. Horoz a, I. Arslan b, Y. Ozkale c, A. Yontem a, M. Ozkale d
a Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey 
b Department of Pediatric Intensive Care, Adana City Training and Research Hospital, Adana, Turkey 
c Department of Pediatric Intensive Care, Baskent University Faculty of Medicine, Adana, Turkey 
d Department of Pediatric Intensive Care, Adana Seyhan State Hospital, Adana, Turkey 

Corresponding author.

Abstract

Objective

We aimed to evaluate and compare the prognostic performance of common pediatric mortality scoring systems (the Pediatric Index of Mortality 2 [PIM2], PIM3, Pediatric Risk of Mortality [PRISM], and PRISM4 scores) to determine which is the most applicable score in our pediatric study cohort.

Methods

This prospective observational multicenter cohort study was conducted in four tertiary-care pediatric intensive care units (PICUs) in Turkey. All children, between 1 month and 16 years old, admitted to the participating PICUs between October 1, 2019, and March 31, 2020, were included in the study. Discrimination between death and survival was assessed by area under the receiver operating characteristic plot (AUC) for each model. The Hosmer–Lemeshow goodness-of-fit (GOF) test was used to assess the calibration of the models,

Results

A total of 570 patients (median age 35 months) were enrolled in the study. The observed mortality rate was 8.2% (47/570). The standardized mortality ratio (SMR) of PIM2, PIM3, PRISM, and PRISM4 with 95% confidence interval (CI) were 0.94 (0.68–1.23), 1.27 (0.93–1.68), 0.86 (0.63–1.13), and 1.5 (1.10–1.97), respectively. The AUC with 95% CI was 0.934 (0.91–0.96) for PIM2, 0.934 (0.91–0.96) for PIM3, 0.917 (0.88–0.95) for PRISM, and 0.926 (0.88–0.97) for PRISM4 models. The Hosmer–Lemeshow test showed that the difference between observed and predicted mortality by PIM3 (p = 0.003) and PRISM4 (p = 0.008) was statistically significant whereas PIM2 (p = 0.28) and PRISM (p = 0.62) showed good calibration.

Conclusion

The overall performance of (both discrimination and calibration) PRISM and PIM2 scoring systems in Turkish pediatric patients aged 1 month to 16 years was accurate and had the best fit for risk groups according to our study. Although PIM3 and PRISM4 have good discriminatory power, their calibration was very poor in our study cohort.

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Keywords : Mortality, Mortality prediction scores, Pediatric intensive care units, Risk adjustment


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© 2022  French Society of Pediatrics. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 29 - N° 6

P. 407-414 - août 2022 Retour au numéro
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