Comparison of Pediatric Sequential Organ Failure Assessment and Pediatric Risk of Mortality III Score as Mortality Prediction in Pediatric Intensive Care Unit

Abstract

Objective: To assess and compare the diagnostic accuracy of the Pediatric Risk of Mortality (PRISM) III score and Pediatric Sequential Organ Failure Assessment (p-SOFA) for the prediction of mortality in critically ill children.Methodology: This was a cross-validation study conducted at the Pediatric Intensive Care Unit (PICU) of the National Institute of Child Health Karachi from February 2021 to July 2021. Two hundred eighty-six critically ill children of age one month to 15 years of either gender staying in PICU for more than 24 hours were included. Within 24 hours of admission, the p-SOFA and PRISM III 24 scores were calculated for all eligible children. The outcome of the study was mortality within 30 days of PICU admitted children. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23.Results: The median age was 24 months (range: 1-144 months). The 30-day mortality was estimated as 57%. The p-SOFA and PRISM scores were significantly greater in children who did not survive than survivors. The maximum p-SOFA score (area under the curve (AUC)=0.81, 95% CI=0.76-0.86, p=0.001) and PRISM III 24 score (AUC=0.75, 95% CI=0.69-0.81, p=0.001) had good discrimination for 30-day mortality. For the prediction of 30-day mortality at the cut-off value of p-SOFA>2, the sensitivity was 93.87%, specificity was 38.21%, and accuracy was 69.93%. Whereas at the cut-off value of PRISM III 24 score>8, the sensitivity was 55.83%, specificity was 77.24%, and accuracy was 65.03%. Conclusion:The p-SOFA score is a good predictor for 30-day mortality in critically ill children and had better accuracy than the PRISM III 24 score.

Impact of Optimizing Critical Care Resources in Pediatric Surgery Patients

“…This agreed with Ramteke et al, [26] who stated that PEWS is highly sensitive and specific in predicting mortality. Also, this was in accordance with Baloch et al, [28] who stated that ASA has strong, independent associations with postop medical complications and mortality across procedures. This agreed with Baloch et al, [28] who stated that the pSOFA score is a predictor for 30-day mortality in critically ill children.…”

“…Also, this was in accordance with Baloch et al, [28] who stated that ASA has strong, independent associations with postop medical complications and mortality across procedures. This agreed with Baloch et al, [28] who stated that the pSOFA score is a predictor for 30-day mortality in critically ill children. Univariate and Multivariate predicted that ASA, PEWS, and pSOFA were significant in predicting mortality as univariate predictors but none of them was significant as multivariate.…”

“…Too, agreed with Hackett et al, [27] who stated that SOFA score at admission is useful for predicting outcomes in the general PICU population and is more accurate than SIRS for the definition of pediatric sepsis. Besides, agreed with Baloch et al, [28] who stated that there is a linear trend between the probability of death and the PEWS.…”

Pediatric Sequential Organ Assessment Score: A Comprehensive Review of the Prognostic Marker in the Pediatric Intensive Care Unit

“…Various prognostic scoring systems, such as the Pediatric Index of Mortality (PIM and PIM2), Pediatric Risk of Mortality (PRISM, PRISM3), SOFA, pSOFA score, and the Pediatric Logistic Organ Dysfunction (PELOD) score, have been created to anticipate morbidity and mortality in children within the PICU. These tools play a crucial role in treatment planning, offering valuable insights for healthcare professionals in predicting and managing the outcomes of critically ill pediatric patients [ 5 ]. Over the last three decades, various scoring systems tailored for ICU patients have been developed.…”

“…Baloch et al conducted an evaluation comparing the diagnostic precision of the PRISM3 score and pSOFA in predicting mortality among critically ill children [ 5 ]. Children who did not survive exhibited significantly higher pSOFA and PRISM scores compared to survivors.…”