PRISM score evaluation to predict outcome in pediatric patients on admission at an emergency department.
This study was undertaken in order to evaluate for the first time the usefulness of PRISM score to predict outcome in pediatric patients in the Intensive Care Area of the Emergency Department at the Instituto Nacional de Pediatría in Mexico City. A prolective evaluation of PRISM score was done using 100 consecutive pediatric patients admitted to INP-ED between July and November 1992 and considered critically ill by the attending pediatricians to calculate by a lineal logistic model the expected mortality and compare with the observed one. Using a cut-off of r = 0, we evaluated at the same time the sensitivity, specificity and efficiency of this score. Fifty-eight patients were male and 42 were female. The mean age was 51 months with a range of 3 days -192 months. PRISM score for survivors was in general 8.7 +/- 7.2 and 25.8 +/- 14 for nonsurvivors (p < 0.001). Based on the logistic regression coefficients defined by Pollack et al., our sample of 100 patients was estimated to expect 12.91 deaths whereas in fact 11 were observed. Inspection of the survival rates across the different categories of expected mortality showed agreement and consistency in relation to original reports (9). The sensitivity, specificity and efficiency in general were 1.0, 0.98 and 0.98, respectively. The PRISM is an objective and efficient method which helps physicians to predict patients' outcome and risk of mortality, providing the medical staff with an epidemiological criteria. Additionally, it may be helpful in decision-making for ICU admissions and correct identification of patients who can benefit from that level of care.
Maulen-Radovan
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Departamento de Urgencias, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F. maulen@cenids.ssa.gob.mx
Gutiérrez Castrellón
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Zaldo Rodríguez
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Martínez Natera
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D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016014:Linear Models; D008297:Male; D017063:Outcome Assessment, Health Care; D010372:Pediatrics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index