Egyptian Pediatric Association Gazette (May 2023)
Effectiveness of PRISM III score in predicting the severity of illness and mortality of children admitted to pediatric intensive care unit: a cross-sectional study
Abstract
Abstract Background The facilities for intensive care are improving day by day in all departments including pediatrics, and prognostication has always been the duty of a physician. Scoring systems are useful to objectively measure the severity and predict the prognosis of sick children. This study was done to assess the severity of illness and mortality risk using the PRISM score in children aged 1 month–18 years, admitted into the pediatric intensive care unit in a tertiary-level hospital. Ninety children of age group 1 month–18 years admitted to the pediatric intensive care unit, satisfying the inclusion and exclusion criteria, were selected after obtaining consent from the parents. A careful history, physical examination, systemic examination, and relevant blood investigations were performed and documented based on the Pediatric Risk Mortality score (PRISM). The relationship between the total prism score obtained and the outcome in terms of mortality, and severity based on the need for either ventilator support or inotrope support or ICU stay of more than 5 days, was studied using appropriate statistical tools. Results The male to female ratio was 53.3% and 46.7%, with a mortality of 10% and severity of 24%. The average value of the PRISM score was 12 to predict mortality, with 100% sensitivity and 91% specificity. PRISM score of 7 had 100% sensitivity and 95% specificity in predicting severe illness. There was a significant association between a low Glasgow coma scale, pupillary reaction, low systolic blood pressure, acidosis, high blood glucose level, and high serum creatinine with the severity of illness. Conclusions The present study demonstrates that Pediatric Risk Mortality score III (PRISM III) acts as an excellent discriminative tool for predicting both mortality and severity of illness of children admitted to the pediatric intensive care unit. The area under the ROC curves was 99% for both. As the PRISM score increases, both mortality risk increases and the risk of severity of illness also increases.
Keywords
