Performance Of Pediatric Risk Of Mortality Score Among Critically Ill Children With Heart Disease

Title

Performance Of Pediatric Risk Of Mortality Score Among Critically Ill Children With Heart Disease

Creator

Russell R A; Rettiganti M; Brundage N; Jeffries H E; Gupta P

Identifier

DOI: 10.1177/2150135117704656

Publisher

World Journal For Pediatric And Congenital Heart Surgery

Date

2017

Subject

Prism-3; Children; Critical Illness; Mortality; Standardized Mortality Ratio

Description

OBJECTIVE: To evaluate the performance of the Pediatric Risk of Mortality 3 (PRISM-3) score in critically ill children with heart disease. METHODS: Patients <18 years of age admitted with cardiac diagnoses (cardiac medical and cardiac surgical) to one of the participating pediatric intensive care units in the Virtual Pediatric Systems, LLC, database were included. Performance of PRISM-3 was evaluated with discrimination and calibration measures among both cardiac surgical and cardiac medical patients. RESULTS: The study population consisted of 87,993 patients, of which 49% were cardiac medical patients (n = 43,545) and 51% were cardiac surgical patients (n = 44,448). The ability of PRISM-3 to distinguish survivors from nonsurvivors was acceptable for the entire cohort (c-statistic 0.86). However, PRISM-3 did not perform as well when stratified by varied severity of illness categories. Pediatric Risk of Mortality 3 underpredicted mortality among patients with lower severity of illness categories (quintiles 1-4) whereas it overpredicted mortality among patients with greatest severity of illness category (fifth quintile). When stratified by Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STS-EACTS) categories, PRISM-3 overpredicted mortality among the STS-EACTS mortality categories 1, 2, and 3 and underpredicted mortality among the STS-EACTS mortality categories 4 and 5. Pediatric Risk of Mortality 3 overpredicted mortality among centers with high cardiac surgery volume whereas it underpredicted mortality among centers with low cardiac surgery volume. CONCLUSION: Data from this large multicenter study do not support the use of PRISM-3 in cardiac surgical or cardiac medical patients. In this study, the ability of PRISM-3 to distinguish survivors from nonsurvivors was fair at best, and the accuracy with which it predicted death was poor.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Citation List Month

September 2017 List

PMID

PMID: 28696880

URL Address

https://www.ncbi.nlm.nih.gov/pubmed/28696880

Citation

Russell R A; Rettiganti M; Brundage N; Jeffries H E; Gupta P, “Performance Of Pediatric Risk Of Mortality Score Among Critically Ill Children With Heart Disease,” Pediatric Palliative Care Library, accessed October 24, 2021, https://pedpalascnetlibrary.omeka.net/items/show/10788.

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