COMPARISON OF THREE PROGNOSTIC SCORES (PRISM, PELOD AND PIM 2) AT PEDIATRIC INTENSIVE CARE UNIT UNDER PAKISTANI CIRCUMSTANCES
AbstractBackground: To compare the performance of the Pediatric Risk of Mortality (PRISM), thePediatric Index of Mortality 2 (PIM 2) and Pediatric Logistic Organ Dysfunction (PELOD) scoresat general pediatric intensive care unit in a developing country setting, investigating the relationbetween observed and predicted mortality. Method: A contemporary cohort study was undertakenat 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 thepublished formulae. Statistical analysis included Standardized Mortality Rate (SMR), HosmerLemeshow goodness of fit test, receiver operating curve (ROC) characteristics and Spearman’scorrelation 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%) andPELOD: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 byPRISM 0.78 (0.67-0.89) and PELOD 0.77 (0.68-0.87). Spearman’s correlation r between PRISMand PIM 2 returned 0.74 (p < 0.001). Conclusion: PRISM as well as PIM 2 is validated for PICUsetting in Pakistani circumstances. PELOD performed poorly. PIM 2 has advantages over PRISMfor stratification of patients in clinical trials.Key words:Prognostic score; PRISM; PIM 2; PELOD; Mortality
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