The performance of pediatric risk of mortality in inter-hospital transport of critically ill pediatric patients

Abstract

Objective To assess the performance of pediatric risk of mortality (PRISM) in predicting mortality probability in inter-hospital transport of critically ill pediatric patients by a perspective study. Methods Four hundred and twelve pediatric patients with inter-hospital transportations were recruited in the study from 1th August 2012 to 31th May 2013. The information on demographic characteristics, the reasons for inter-hospital transport, the category of disease and the severity of illness was collected. Information on age, sex, diagnosis, length of stay in PICU, the outcome and the variables required to calculate PRISM score were collected. The logistic regression model developed in the learning sample was evaluated in the test sample by calculating the area under the receiver operating characteristic plot (Az ROC) to assess discrimination between death and survival. Calibration across deciles of risk was evaluated using the Hosmer-Lemeshow goodness-of-fit χ2 test. Results Among 412 inter-hospital transport of critically ill pediatric patients, the majority of patients (89.08%, 367/412) were neonates and infants, and above two thirds of the children were suffering from respiratory diseases (172 cases), and miscellaneous diseases (169 cases). Forty-five (10.92%) inter-hospital transport of critically ill pediatric patients died at the time of hospitalization. The area under the receiver-operating characteristic curve was 0.829 (95%confidence intervals 0.768~0.890) for PRISM. The Hosmer-Lemeshow test gave a chi-square of 8.75 (P=0.364) for PRISM. Conclusion The PRISM score is demonstrated good discrimination and calibration in predicting death probability of inter-hospital transport of critically ill pediatric patients. Key words: Inter-hospital transport; Critically ill pediatric patients; Pediatric risk of mortality