Why the study?
PICU mortality risk is typically estimated using objective scales, but human perception may add prognostic information through fuzzy logic.
Does a hybrid model combining subjective staff assessment and objective scales improve mortality risk prediction accuracy in children admitted to the PICU?
Observational (n=599)
Yes
Does a hybrid model combining subjective staff assessment and objective scales improve mortality risk prediction accuracy in children admitted to the PICU?
Absolute Event Rate: 92.6% vs 86.3%
A hybrid model combining subjective staff assessment and objective scales (PIM2) achieved 96.4% accuracy in predicting PICU mortality, outperforming objective scales alone.
Fuzzy logic models using staff perceptions may refine PICU mortality estimates; leaves open need for prospective validation before adoption.
Introduction . The mortality risk in children admitted to Pediatric Intensive Care Units (PICU) is usually estimated by means of validated scales, which only include objective data among their items. Human perceptions may also add relevant information to prognosticate the risk of death, and the tool to use this subjective data is fuzzy logic. The objective of our study was to develop a mathematical model to predict mortality risk based on the subjective perception of PICU staff and to evaluate its accuracy compared to validated scales. Methods . A prospective observational study in two PICUs (one in Spain and another in Latvia) was performed. Children were consecutively included regardless of the cause of admission along a two‐year period. A fuzzy set program was developed for the PICU staff to record the subjective assessment of the patients’ mortality risk expressed through a short range and a long range, both between 0% and 100%. Pediatric Index of Mortality 2 (PIM2) and Therapeutic Intervention Scoring System 28 (TISS28) were also prospectively calculated for each patient. Subjective and objective predictions were compared using the logistic regression analysis. To assess the prognostication ability of the models a stratified B ‐random K ‐fold cross‐validation was performed. Results . Five hundred ninety‐nine patients were included, 308 in Spain (293 survivors, 15 nonsurvivors) and 291 in Latvia (282 survivors, 9 nonsurvivors). The best logistic classification model for subjective information was the one based on MID (midpoint of the short range), whereas objective information was the one based on PIM2. Mortality estimation performance was 86.3% for PIM2, 92.6% for MID, and the combination of MID and PIM2 reached 96.4%. Conclusions . Subjective assessment was as useful as validated scales to estimate the risk of mortality. A hybrid model including fuzzy information and probabilistic scales (PIM2) seems to increase the accuracy of prognosticating mortality in PICU.
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Rey et al. (2022) conducted an observational in Children admitted to Pediatric Intensive Care Units (PICU) (n=599). Subjective assessment of mortality risk (MID) vs. Pediatric Index of Mortality 2 (PIM2) was evaluated on Mortality estimation performance.
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