Key result
Severity of illness scores including PIM2, PRISM III, and PELOD calculated on PICU admission were not associated with mortality in pediatric patients receiving ECMO, with AUCs of 0.52, 0.52, and 0.51 respectively.
Why the study?
Severity of illness and mortality risk prediction scores based on the first 24 hours of ICU admission have not been validated in the pediatric ECMO population.
Do severity of illness scores (PIM2, PRISM III, PELOD) accurately predict mortality in pediatric patients receiving ECMO?
Cohort (n=655)
Yes
Do severity of illness scores (PIM2, PRISM III, PELOD) accurately predict mortality in pediatric patients receiving ECMO?
Standard pediatric ICU severity of illness scores (PIM2, PRISM III, PELOD) have poor discrimination for mortality in pediatric patients receiving ECMO and should not be used for prognostication in this population.
Poor discrimination by standard scores in pediatric ECMO warrants caution in prognostication; leaves open development of ECMO-specific models.
Though commonly used for adjustment of risk, severity of illness and mortality risk prediction scores, based on the first 24 h of intensive care unit (ICU) admission, have not been validated in the pediatric extracorporeal membrane oxygenation (ECMO) population. We aimed to determine the association of Pediatric Index of Mortality 2 (PIM2), Pediatric Risk of Mortality Score III (PRISM III) and Pediatric Logistic Organ Dysfunction (PELOD) scores with mortality in pediatric patients on ECMO. This was a retrospective cohort study of children ≤18 years of age included in the Pediatric ECMO Outcomes Registry (PEDECOR) from 2014 to 2018. Logistic regression and Receiver Operating Characteristics (ROC) curves were used to calculate the area under the curve (AUC) to evaluate association of mortality with the scores. Of the 655 cases, 289 (44.1%) did not survive until hospital discharge. AUCs for PIM2, PRISM III, and PELOD predicting mortality were 0.52, 0.52, and 0.51 respectively. PIM2, PRISM III, and PELOD scores are not associated with odds of mortality for pediatric patients receiving ECMO. These scores for a general pediatric ICU population should not be used for prognostication or risk stratification of a select population such as ECMO patients.
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Pinto et al. (2021) conducted a cohort in Pediatric patients requiring extracorporeal membrane oxygenation (ECMO) (n=655). Severity of illness scores (PIM2, PRISM III, PELOD) was evaluated on Mortality prior to hospital discharge (OR 1.07, 95% CI 0.99-1.17, p=0.088). Severity of illness scores including PIM2, PRISM III, and PELOD calculated on PICU admission were not associated with mortality in pediatric patients receiving ECMO, with AUCs of 0.52, 0.52, and 0.51 respectively.
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