Simplified PRISM III score and outcome in the pediatric intensive care unit.
BACKGROUND
To evaluate the association of the PRISM III (pediatric risk of mortality) score with the infant outcome in the pediatric intensive care unit (PICU), and to determine if this score could be simplified.


METHODS
A prospective cohort study was carried out with 170 infants who were consecutively admitted to the PICU. The PRISM III score with 17 physiologic variables was performed during the first 8 h of admission to the unit. Statistical analysis was done with logistic regression, odds ratios (OR) with 95% confidence intervals (95% CI), and receiver operating curve. The Alfa value was set at 0.05.


RESULTS
There were 42 deaths (24.7%). The two main causes of death were septic shock (28.6%) and head trauma (16.7%). The PRISM III score had a sensitivity of 0.71, and a specificity of 0.64 as a mortality predictor. Out of the 17 physiologic variables only four of them were significant: abnormal pupillary reflexes OR 9.9 (95% CI, 3.5-28.4), acidosis OR 3.1 (95% CI, 2.0-4.9), blood urea nitrogen concentration OR 1.03 (95% CI, 1.01-1.04), and white blood cell count OR 1.02 (95% CI, 1.01-1.03). The whole logistic regression model had a coefficient of determination R(2) = 0.219, P < 0.001.


CONCLUSIONS
In this setting, the PRISM III score had good sensitivity and specificity to predict mortality. This score could be simplified using only the four variables that were significant in this study. This modified PRISM III score could reduce the cost of patient care especially in developing countries PICU.
De León
Ana Lilia Ponce-Ponce
AL
Unit of Clinical Epidemiological Research, Department of Pediatrics, Mexican Institute of Social Security, Leon, Mexico.
Romero-Gutiérrez
Gustavo
G
Valenzuela
Carlos Aldana
CA
González-Bravo
Francisco Ernesto
FE
D002423:Cause of Death; D002675:Child, Preschool; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000401:mortality; D003906:Developing Countries; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008800:Mexico / Q000453:epidemiology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000401:mortality