COMPARISON OF THREE PROGNOSTIC SCORES (PRISM, PELOD AND PIM 2) AT PEDIATRIC INTENSIVE CARE UNIT UNDER PAKISTANI CIRCUMSTANCES
Abstract
Background: To compare the performance of the Pediatric Risk of Mortality (PRISM), thePediatric Index of Mortality 2 (PIM 2) and Pediatric Logistic Organ Dysfunction (PELOD) scores
at general pediatric intensive care unit in a developing country setting, investigating the relation
between observed and predicted mortality. Method: A contemporary cohort study was undertaken
at Pediatric Intensive Care Unit (PICU), Children's Hospital, Institute of Child Health, Lahore,
Pakistan. 131 consecutive admissions fulfilling the inclusion criteria were enrolled in the study.
PRISM, PIM 2 and PELOD calculations were performed as set out by original articles, using the
published formulae. Statistical analysis included Standardized Mortality Rate (SMR), Hosmer
Lemeshow goodness of fit test, receiver operating curve (ROC) characteristics and Spearman's
correlation test. Results: 139 patients were admitted to PICU. 38 presented exclusion criteria. 29
(28.7%) patients died. Estimated mortality was; PRISM: 19.7(19.5%), PIM: 21.01(20.5%) and
PELOD:18.4(18.3%). SMR was 1.47 (SD ± 0.19), 1.4 (SD ± 0.19) and 1.57 (SD ± 0.19),
respectively. PRISM had better calibration (x2 = 7.49, p = 0.49) followed by PIM 2 (x2 = 9.65,
p = 0.29). PIM 2 showed best discrimination with area under ROC = 0.88 (0.81-0.94) followed by
PRISM 0.78 (0.67-0.89) and PELOD 0.77 (0.68-0.87). Spearman's correlation r between PRISM
and PIM 2 returned 0.74 (p < 0.001). Conclusion: PRISM as well as PIM 2 is validated for PICU
setting in Pakistani circumstances. PELOD performed poorly. PIM 2 has advantages over PRISM
for stratification of patients in clinical trials.
Key words:Prognostic score; PRISM; PIM 2; PELOD; Mortality
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