Abstract
BackgroundScores can assess the severity and course of disease and predict outcome in an objective manner. This information is needed for proper risk assessment and stratification. Furthermore, scoring systems support optimal patient care, resource management and are gaining in importance in terms of artificial intelligence.ObjectiveThis study evaluated and compared the prognostic ability of various common pediatric scoring systems (PRISM, PRISM III, PRISM IV, PIM, PIM2, PIM3, PELOD, PELOD 2) in order to determine which is the most applicable score for pediatric sepsis patients in terms of timing of disease survey and insensitivity to missing data.MethodsWe retrospectively examined data from 398 patients under 18 years of age, who were diagnosed with sepsis. Scores were assessed at ICU admission and re-evaluated on the day of peak C-reactive protein. The scores were compared for their ability to predict mortality in this specific patient population and for their impairment due to missing data.ResultsPIM (AUC 0.76 (0.68–0.76)), PIM2 (AUC 0.78 (0.72–0.78)) and PIM3 (AUC 0.76 (0.68–0.76)) scores together with PRSIM III (AUC 0.75 (0.68–0.75)) and PELOD 2 (AUC 0.75 (0.66–0.75)) are the most suitable scores for determining patient prognosis at ICU admission. Once sepsis is pronounced, PELOD 2 (AUC 0.84 (0.77–0.91)) and PRISM IV (AUC 0.8 (0.72–0.88)) become significantly better in their performance and count among the best prognostic scores for use at this time together with PRISM III (AUC 0.81 (0.73–0.89)). PELOD 2 is good for monitoring and, like the PIM scores, is also largely insensitive to missing values.ConclusionOverall, PIM scores show comparatively good performance, are stable as far as timing of the disease survey is concerned, and they are also relatively stable in terms of missing parameters. PELOD 2 is best suitable for monitoring clinical course.
Highlights
Detection of critically ill patients is essential for timely, good care in a suitable facility
Today’s scores, which are especially suitable for children, are, for example, the Pediatric Risk of Mortality (PRISM) score, from which its further developments, namely the PRISM III and PRISM IV scores, the Pediatric Index of Mortality (PIM) score, were derived, the PIM2 and PIM3 scores and the PELOD (Pediatric Logistic Organ Dysfunction) score followed by the PELOD 2 score (Leteurtre et al, 2006; Leteurtre et al, 2013; Leteurtre et al, 1999; Pollack et al, 2016; Pollack, Patel & Ruttimann, 1996b; Pollack, Ruttimann & Getson, 1988; Shann et al, 1997; Slater, Shann & Pearson, 2003; Straney et al, 2013)
The most affected organ in terms of underlying disease was the respiratory system in 26.8% of the children followed by diseases of the central nervous system (22.3%) and the cardiovascular system (21.6%)
Summary
Detection of critically ill patients is essential for timely, good care in a suitable facility. The first scoring systems were developed for adults and were less suitable for use in children. Scores can assess the severity and course of disease and predict outcome in an objective manner. This information is needed for proper risk assessment and stratification. This study evaluated and compared the prognostic ability of various common pediatric scoring systems (PRISM, PRISM III, PRISM IV, PIM, PIM2, PIM3, PELOD, PELOD 2) in order to determine which is the most applicable score for pediatric sepsis patients in terms of timing of disease survey and insensitivity to missing data. PIM scores show comparatively good performance, are stable as far as timing of the disease survey is concerned, and they are relatively stable in terms of missing parameters.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
