El-Nawawy Ahmed
Pediatric Department, Faculty of Medicine, Alexandria University, Ibrahimeya, Egypt.
J Trop Pediatr. 2003 Apr;49(2):109-14. doi: 10.1093/tropej/49.2.109.
The aim of this prospective study was to evaluate the use of pediatric risk of mortality (PRISM) score to predict the patient outcome in Alexandria Pediatric Intensive Care Unit (PICU). The study included all admissions to a tertiary care teaching hospital for 13 months. All patients were subjected to thorough history taking and clinical examination. The PRISM score was obtained within 8 h from admission (including 14 parameters with 34 variables). The primary affected system, referral site, number of organ failure on admission, length of hospital stay (LOS) and outcome of patients were recorded. The bed occupancy rate, turnover rate, average LOS, total and adjusted death rates were also recorded. Results showed that the total and adjusted mortality rates were 50 and 38 per cent respectively (n = 205/406 and 125/326, respectively). The mean PRISM score on admission was 26. Non-survivors showed a significantly higher mean score compared with survivors (36 vs. 17). Non-survivors compared with survivors, were significantly younger (12 vs. 23 months), had shorter LOS (3.8 vs. 5.3 days), three or four organ system failure on admission (77 vs. 25 per cent, and 9 vs. 0 per cent of patients) and had significantly higher percentage of sepsis syndrome and neurological diseases, as the primary affected system (20 vs. 10 per cent and 26 vs. 16 per cent). The PRISM score showed a significant positive correlation only with the number of organ failure on admission (r = 0.8104; p < 0.001). The cut-off point of survival was a PRISM score 26 with expected/observed ratio of 1.05 for non-survivors with 91.6 per cent accuracy. Multiple logistic regression analysis revealed that PRISM score, LOS, and the primary affected system were relevant predictors of patient outcome in PICU. In conclusion, the PRISM score is proved to be a good predictor of outcome for children admitted to a PICU with a cut-off point of 26. The mortality in the PICU is affected by LOS, primary system affected, and number of organ failure on admission.
这项前瞻性研究的目的是评估小儿死亡风险（PRISM）评分在预测亚历山大儿科重症监护病房（PICU）患者预后方面的应用。该研究纳入了一家三级护理教学医院13个月内的所有入院患者。所有患者均接受了详细的病史采集和临床检查。PRISM评分在入院8小时内获得（包括14个参数和34个变量）。记录主要受累系统、转诊地点、入院时器官衰竭数量、住院时间（LOS）以及患者的预后情况。还记录了床位占用率、周转率、平均住院时间、总死亡率和校正死亡率。结果显示，总死亡率和校正死亡率分别为50%和38%（分别为n = 205/406和125/326）。入院时PRISM评分的平均值为26。与幸存者相比，非幸存者的平均评分显著更高（36对17）。与幸存者相比，非幸存者年龄显著更小（12个月对23个月），住院时间更短（3.8天对5.3天），入院时出现三个或四个器官系统衰竭的比例更高（分别为77%对25%，以及9%对0%的患者），作为主要受累系统的脓毒症综合征和神经系统疾病的比例也显著更高（分别为20%对10%和26%对16%）。PRISM评分仅与入院时器官衰竭的数量呈显著正相关（r = 0.8104；p < 0.001）。生存的截断点是PRISM评分为26，非幸存者的预期/观察比值为1.05，准确率为91.6%。多因素逻辑回归分析显示，PRISM评分、住院时间和主要受累系统是PICU患者预后的相关预测因素。总之，PRISM评分被证明是入住PICU儿童预后的良好预测指标，截断点为26。PICU的死亡率受住院时间、主要受累系统和入院时器官衰竭数量的影响。
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