COMPARISON OF PEDIATRIC INDEX OF MORTALITY (PIM)-3 AND PEDIATRIC SEQUENTIAL ORGAN FAILURE ASSESSMENT (pSOFA) SCORES TO PREDICT MORTALITY IN PEDIATRIC INTENSIVE CARE UNIT

ANKIT KUMAR PAWAR; GAURAV KUMAR PRAJAPATI; KANCHAN CHOUBEY; RASHMI RANDA

doi:10.22159/ajpcr.2024.v17i6.51384

Authors

ANKIT KUMAR PAWAR Department of Paediatrics, SRPR Multispeciality Hospital, Surajpur, Chhattisgarh, India.
GAURAV KUMAR PRAJAPATI Department of Hematogenic, ICMR-NIRTH, Jabalpur, Madhya Pradesh, India
KANCHAN CHOUBEY Department of Pediatrics, District Hospital, Narmadapuram, Madhya Pradesh, India
RASHMI RANDA Department of Pediatrics, GMC, Bhopal, Madhya Pradesh, India.

DOI:

https://doi.org/10.22159/ajpcr.2024.v17i6.51384

Keywords:

Pediatric index of mortality-3, Pediatric sequential organ failure assessment, Pediatric intensive care unit, Mortality scores.

Abstract

Objective: The objective of the study is to evaluate and compare the pediatric index of mortality (PIM)-3 and pediatric sequential organ failure assessment (pSOFA) scores to predict mortality in pediatric intensive care unit (PICU).

Methods: This cross-sectional study was conducted prospectively in PICU over 1 year. All consecutive patients admitted to the PICU aged 1 month to 12 years on designated study days were enrolled in the study (n=400). Mortality scores were calculated on the same day of admission using an Android calculator application.

Results: The mean PIM-3 score in the non-survivor group (n=48) was higher, i.e., −0.81 (−2.05 to −0.44) than in the survivor group (n=352), i.e., −4.67 (−5.83 to −4.05) with p<0.001. The pSOFA score was also found higher in the non-survivor group, i.e., 11 interquartile range (IQR) (8–11) as compared to the survivor group, i.e., 3 IQR (2–5) with statistically significant difference (p<0.001). The median value of sensitivity and specificity for PIM-3 was reported to be 97.46% and 86.67%, respectively. The median value of sensitivity and specificity for pSOFA was 97.72% and 85.11%, respectively. The area under-receiver operating characteristic (AU-ROC) 0.9145 (95% confidence interval [CI]: 0.8595–0.9695) for the PIM-3 was almost equal to the AU-ROC of pSOFA score, i.e., 0.9554 (95% CI: 0.918–0.992). Both scores were positively associated with each other (r=0.807, <0.0001)

Conclusion: Both PIM-3 and pSOFA scores were effective in predicting mortality in critically ill children.

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References

Niedner MF, Muething SE, Sutcliffe KM. The high-reliability pediatric Intensive care unit. Pediatr Clin North Am. 2013;60(3):563-80. doi: 10.1016/j.pcl.2013.02.005, PMID: 23639655

Scanlon MC, Mistry KP, Jeffries HE. Determining pediatric intensive care unit quality indicators for measuring pediatric intensive care unit safety. Pediatr Crit Care Med. 2007;8(2 Suppl) S3-10. doi: 10.1097/01. PCC.0000257485.67821.77, PMID: 17496830

Straney L, Clements A, Parslow RC, Pearson G, Shann F, Alexander J, et al. Paediatric index of mortality 3: An updated model for predicting mortality in pediatric intensive care*. Pediatr Crit Care Med. 2013;14(7):673-81. doi: 10.1097/PCC.0b013e31829760cf, PMID: 23863821

Pollack MM, Patel KM, Ruttimann UE. PRISM III: An updated pediatric risk of mortality score. Crit Care Med. 1996;24(5):743-52. doi: 10.1097/00003246-199605000-00004, PMID: 8706448

Matics TJ, Sanchez-Pinto LN. Adaptation and validation of a pediatric sequential organ failure assessment score and evaluation of the Sepsis-3 definitions in critically ill children. JAMA Pediatr. 2017;171(10):e172352. doi: 10.1001/jamapediatrics.2017.2352, PMID: 28783810

Nel ED. Severe acute malnutrition. Curr Opin Clin Nutr Metab Care. 2016 May;19(3):234-8. doi: 10.1097/MCO.0000000000000269, PMID: 26963580

Turner EL, Nielsen KR, Jamal SM, von Saint André-von Arnim A, Musa NL. A review of pediatric critical care in resource-limited settings: A look at past, present, and future directions. Front Pediatr. 2016;4:5. doi: 10.3389/fped.2016.00005, PMID: 26925393

Baloch SH, Shaikh I, Gowa MA, Lohano PD, Ibrahim MN. Comparison of pediatric sequential organ failure assessment and pediatric risk of mortality III score as mortality prediction in pediatric Intensive Care Unit. Cureus. 2022;14(1):e21055. doi: 10.7759/cureus.21055, PMID: 35155020

Mianling Z, Yuge H, Tufeng L, Lu X, Ting T, Miaofen L, et al. Performance of the pediatric sequential organ failure assessment score in assessing the prognosis of children with sepsis in a PICU of a developing country: A single-center retrospective observational study. Iran J Pediatr. 2019;29(5):e89024. doi: 10.5812/ijp.89024

Mohamed El-Mashad G, Said El-Mekkawy M, Helmy Zayan M. Paediatric sequential organ failure assessment (pSOFA) score: A new mortality prediction score in the paediatric intensive care unit. An Pediatr (Engl Ed). 2020;92(5):277-85. doi: 10.1016/j.anpedi.2019.05.018, PMID: 31784324

Sankar J, Gulla KM, Kumar UV, Lodha R, Kabra SK. Comparison of outcomes using Pediatric Index of Mortality (PIM) -3 and PIM-2 models in a pediatric Intensive Care Unit. Indian Pediatr. 2018;55(11):972-4. doi: 10.1007/s13312-018-1421-2, PMID: 30587646

Malhotra D, Nour N, El Halik M, Zidanc M. Performance and analysis of pediatric index of mortality 3 score in a pediatric ICU in Latifa Hospital, Dubai, UAE. Dubai Med J. 2019;3:19-25.

Lalitha AV, Satish JK, Reddy M, Ghosh S, George J, Pujari C. Sequential organ failure assessment score as a predictor of outcome in sepsis in pediatric Intensive Care Unit. J Pediatr Intensive Care. 2021;10(2):110- 7. doi: 10.1055/s-0040-1714705, PMID: 33884211

Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286(14):1754-8. doi: 10.1001/jama.286.14.1754

Shen Y, Jiang J. Meta-analysis for the prediction of mortality rates in a pediatric Intensive Care Unit using different scores: PRISM-III/IV, PIM-3, and PELOD-2. Front Pediatr. 2021;9:712276. doi: 10.3389/ fped.2021.712276, PMID: 34504815

Gattinoni L, Pesenti A, Matthay M. Understanding blood gas analysis. Intensive Care Med. 2018;44(1):91-3. doi: 10.1007/s00134-017- 4824-y, PMID: 28497267

Barbara P, Graziano C, Caputo W, Litvak I, Battinelli D, Hahn B. The quick sequential organ failure assessment (qSOFA) identifies septic patients in the out-of-hospital setting. Am J Emerg Med. 2018;36(6):1022-6. doi: 10.1016/j.ajem.2018.01.073, PMID: 29426799

Lee EJ, Lee B, Kim YS, Choi YH, Kwak YH, Park JD. Clinical implications of discrepancies in predicting pediatric mortality between Pediatric Index of Mortality 3 and Pediatric Logistic Organ Dysfunction-2. Acute Crit Care. 2022 Aug;37(3):454-461. doi: 10.4266/acc.2021.01480. Epub 2022 Jul 29. PMID: 35977901; PMCID: PMC9475145.