6673 Comparison of pediatric index of mortality-3 (PIM-3) & pediatric sequential organ failure assessment score (pSOFA) in predicting mortality in a PICU

Objectives There needs to be an objective and reproducible way of assessing the severity of illness and risk of mortality among children admitted in PICU, to prioritize the resources.¹ Out of all scores which predict the outcome in PICU, PIM-3 & pSOFA are the most recent ones, but their calibration and discrimination power should be validated in our population, before implementing.² ³ Compared to PIM3, pSOFA is relatively naive but simple in terms of calculation & less resource demanding.³ There's a scarcity of data in literature comparing the efficacy of these two. Hence our primary objectives were to compare the performance of pSOFA and PIM-3 scores in PICU & determine the clinical parameters that are associated with the outcome among critically ill children from our part of the world. Methods For this hospital based prospective observational study, done in government medical college, Thiruvananthapuram (Kerala, India), all consecutively admitted children in the PICU, with age between 1month & 12years during period of Oct-2021 to Sept-2022(excluding those required cardiopulmonary resuscitation before admission) were enrolled. PIM3 and pSOFA scores were calculated at admission & followed up for outcome. Mortality discrimination of the scores was calculated using the ROC curves, Youden index & standardised mortality ratios(SMR), Hosmer-Lemeshow goodness-of-fit test was performed for calibration, also chi-square test and logistic regression were used to detect the association between clinical parameters and outcome. Results Of the 650 children enrolled (male: female 1.01), 44 (6.76%) expired. The median age of the study subjects was 13.5 months (IQR-68). The major reasons for ICU admission (41.4%) as well as mortality(40.9%) were respiratory diseases. The areas under ROC curves for PIM3 and pSOFA were 0.867 (95% CI: 0.822–0.911) and 0.914 (95% CI: 0.87–0.959). The goodness-of-fit test showed a good calibration across deciles of risk for the two scores with P values being >0.05. The SMR was 1.002 and 1 for PIM3 and pSOFA, respectively. Hypotension at admission, inotrope requirement, poor GCS and low SpO2/FiO2 ratio were associated with poor outcome. Conclusion Though both scores demonstrated good calibration, pSOFA score has performed better in terms of discrimination ability, ease of data collection and simplicity of computation. Even though done in an Indian setting, this study could be generalized to other developing countries. Further studies can be done to improve pSOFA score by incorporating lactate value at admission. References Raghavendra, et al. A prospective cohort study for the comparison of two prognostic scores – PRISM 3 and PIM 2 in a Pediatric Intensive Care UnitJournal of Evolution of Medical and Dental. Sciences 2014 September 18;3(45):10954–10966. Jung, et al. Validation of pediatric index of mortality 3 for predicting mortality among patients admitted to a pediatric intensive care unit, Acute and Critical Care 2018 August;33(3):170–177. Mashad, et al. Paediatric sequential organ failure assessment (pSOFA) score: a new mortality prediction score in the paediatric intensive care unit, analesdepediatria, 4 December, 2019.