Key result
Both PRISM III and PIM 2 scores overestimated mortality (predicted 23.52% and 23.72% vs observed 18.34%) and showed regular discrimination (AUC 0.71 and 0.76) in pediatric cancer ICU patients.
Why the study?
The performance of the PRISM III and PIM 2 scores needed assessment in patients admitted to a cancer pediatric intensive care unit.
Do PRISM III and PIM 2 scores accurately predict mortality in pediatric cancer patients admitted to the intensive care unit?
Cohort (n=338)
No
Do PRISM III and PIM 2 scores accurately predict mortality in pediatric cancer patients admitted to the intensive care unit?
PRISM III and PIM 2 scores overestimate mortality and have only regular discriminatory ability in pediatric cancer ICU patients, highlighting the need for population-specific prognostic models.
May warrant caution applying PRISM III/PIM 2 to pediatric cancer ICU patients; leaves open need for cancer-specific prognostic models.
OBJECTIVE: To assess the performance of Pediatric Risk of Mortality (PRISM) III and Pediatric Index of Mortality (PIM) 2 scores in the pediatric intensive care unit. METHODS: A retrospective cohort study. Data were retrospectively collected from medical records of all patients admitted to the pediatric intensive care unit of a cancer hospital from January 2017 to June 2018. RESULTS: The mean PRISM III score was 15, and PIM 2, 24%. From the 338 studied patients, 62 (18.34%) died. The PRISM III estimated mortality was 79.52 patients (23.52%) and for PIM 2 80.19 patients (23.72%), corresponding to a standardized mortality ratio (95% confidence interval: 0.78 for PRISM II and 0.77 for PIM 2). The Hosmer-Lemeshow chi-square test was 11.56, 8df, 0.975 for PRISM II and 0.48, 8df, p = 0.999 for PIM 2. The area under the Receiver Operating Characteristic curve was 0.71 for PRISM III and 0.76 for PIM 2. CONCLUSION: Both scores overestimated mortality and have shown a regular ability to discriminate between survivors and non-survivors. Models should be developed to quantify the severity of cancer pediatric patients in Pediatric Intensive Care Units and to predict the mortality risk accounting for their peculiarities.
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Farias et al. (2021) conducted a cohort in Pediatric cancer requiring intensive care (n=338). PRISM III and PIM 2 scores was evaluated on mortality (SMR 0.78 for PRISM III and 0.77 for PIM 2). Both PRISM III and PIM 2 scores overestimated mortality (predicted 23.52% and 23.72% vs observed 18.34%) and showed regular discrimination (AUC 0.71 and 0.76) in pediatric cancer ICU patients.
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