Reliability of PRISM and PIM scores in paediatric intensive care.
OBJECTIVE
To assess the reliability of mortality risk assessment using the Paediatric Risk of Mortality (PRISM) score and the Paediatric Index of Mortality (PIM) in daily practice.


METHODS
Twenty seven physicians from eight tertiary paediatric intensive care units (PICUs) were asked to assess the severity of illness of 10 representative patients using the PRISM and PIM scores. Physicians were divided into three levels of experience: intensivists (>3 years PICU experience, n = 12), PICU fellows (6-30 months of PICU experience, n = 6), and residents (<6 months PICU experience, n = 9). This represents all large PICUs and about half of the paediatric intensivists and PICU fellows working in the Netherlands.


RESULTS
Individual scores and predicted mortality risks for each patient varied widely. For PRISM scores the average intraclass correlation (ICC) was 0.51 (range 0.32-0.78), and the average kappa score 0.6 (range 0.28-0.87). For PIM scores the average ICC was 0.18 (range 0.08-0.46) and the average kappa score 0.53 (range 0.32-0.88). This variability occurred in both experienced and inexperienced physicians. The percentage of exact agreement ranged from 30% to 82% for PRISM scores and from 28 to 84% for PIM scores.


CONCLUSIONS
In daily practice severity of illness scoring using the PRISM and PIM risk adjustment systems is associated with wide variability. These differences could not be explained by the physician's level of experience. Reliable assessment of PRISM and PIM scores requires rigorous specific training and strict adherence to guidelines. Consequently, assessment should probably be performed by a limited number of well trained professionals.
van Keulen
J G
JG
Department of Pediatrics, VU University Medical Center, Amsterdam, Netherlands.
Polderman
K H
KH
Gemke
R J B J
RJ
D000704:Analysis of Variance; D002983:Clinical Competence; D003422:Critical Care; D003951:Diagnostic Errors; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D019636:Neurodegenerative Diseases / Q000175:diagnosis; D015588:Observer Variation; D010100:Oxygen / Q000502:physiology; D011680:Pupil / Q000502:physiology; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D013997:Time Factors
D010100:Oxygen