Performance of Pediatric Risk of Mortality and Pediatric Index of Mortality in Pediatric Intensive Care Units: a Case Study of Patients with Digestive Diseases

Abstract

Background:

 In patients in intensive care units, gastrointestinal problems occur frequently and often with adverse consequences. The importance of gastrointestinal failure in patients is underestimated. This study that was done in intensive care centers of Mashhad pediatric hospitals evaluated the effectiveness of Pediatric Risk of Mortality (PRISM-3) and Pediatric Index of Mortality (PIM-3) systems in predicting mortality in patients with digestive diseases.

Materials and Methods:

This study was performed on critically ill children aged≤ 18 years who were referred to receive critical care in two hospitals. A comparison was made between the PIM-3 and PRISM-3 scores according to the discrimination (the area under the receiver operating characteristic [AUC] curve), and calibration (agreement between expected and observed mortality).

Results:

A total of 339 patients (median age 5, IQR: 0.76-25 months, 54.6% male) with 54 deaths were considered in the study. PRISM-3 discrimination was more than PIM-3 (AUC=0.779, 0.739) and the difference between AUC scores was significant (P=0.001). There was a good agreement between the observed and predicted mortality by both models with no deviation from the true probabilities suggesting good calibration for our population. There was a significant relationship between the patients' deaths and increased scores of PRISM-3 and PIM-3 models. The weakest prognosis was related to patients with esophageal, gastric, and intestinal problems.

Conclusion:

 It was found that the performance of PRISM-3 in discrimination and calibration of mortality is superior to PIM-3. According to the results of this study, the performance of PRISM-3 in discrimination and calibration to mortality was superior to PIM-3, and the use of scoring systems can predict the mortality of children with gastrointestinal problems and reduce their mortality.