Chegini Victoria, Hatamabadi Hamidreza, Jedari Attaran Sima, Mahyar Abolfazl, Mirzadeh Monirsadat, Chegini Venus
Department of Pediatrics, School of Medicine, Shahid Beheshti University of Medical Sciences.
Department of Emergency Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences.
Arch Acad Emerg Med. 2022 Jul 12;10(1):e58. doi: 10.22037/aaem.v10i1.1738. eCollection 2022.
Limited resources and the large number of children in need of services in the pediatric intensive care unit (PICU) emphasize the need for effective allocation of resources for improving the outcome of at-risk patients. This study aimed to evaluate and compare the accuracy of PRISM4 and PIM3 systems in prediction of in-hospital mortality of patients admitted to PICU.
The present retrospective cross-sectional study was a diagnostic accuracy study performed on patients admitted to PICU of Qods Hospital, Qazvin, Iran, during one year. Scores of PRISM4 and PIM3 scales were calculated for each patient using the available calculators, and the outcome of patients regarding in-hospital mortality was recorded. Finally, screening performance characteristics of the mentioned scales in prediction of patients' mortality were calculated and reported.
218 patients with the mean age of 40.68 ± 37.92 (2-160) months were studied (57.8% female). There was a significant direct correlation between PIM3 score and duration of stay in PICU (p < 0.0001; r = 0.259), need for inotropic drug administration (p = 0.001), and mortality rate (p = 0.001). In addition, area under the receiver operating characteristic (ROC) curve of PIM3 and PRISM4 in prediction of mortality among patients admitted to the PICU was 0.939 (95%CI: 0.880 - 0.998) and 0.660 (95%CI: 0.371 - 0.950), respectively (p = 0.001). Based on the findings, the best cut-off point for PIM3 scale in prediction of mortality was the score of 4 and it was estimated to be the core of 8 for PRISM4 scale. Sensitivity and specificity of PIM3 scale in prediction of mortality in the cut-off of 4 points were 100.00 (95% CI: 56.09- 100.00) and 81.51 (95% CI: 75.47- 86.38), respectively. These measures were 42.85 (95%CI: 11.80- 79.76) and 98.10 (95%CI: 94.89- 99.39) for PRISM4 model, which indicates the higher sensitivity of PIM3 system in this regard.
based on the results of the present study, the accuracy of PIM3 is significantly higher than PRISM4 in prediction of in-hospital mortality among patients admitted to the PICU. It seems that considering the 100% sensitivity of PIM3 in prediction of outcome, this model is a better tool for screening patients who are at risk for in-hospital mortality in order to pay more attention and allocate more resources to improve their outcome.
儿科重症监护病房（PICU）资源有限，而需要服务的儿童数量众多，这凸显了有效分配资源以改善高危患者治疗结果的必要性。本研究旨在评估和比较PRISM4和PIM3系统预测入住PICU患者院内死亡率的准确性。
本回顾性横断面研究是一项针对伊朗加兹温圣城医院PICU收治患者进行的诊断准确性研究。使用可用的计算器为每位患者计算PRISM4和PIM3量表得分，并记录患者的院内死亡结局。最后，计算并报告上述量表在预测患者死亡率方面的筛查性能特征。
共研究了218例患者，平均年龄为40.68±37.92（2 - 160）个月，其中女性占57.8%。PIM3得分与在PICU的住院时间（p < 0.0001；r = 0.259）、使用血管活性药物的需求（p = 0.001）和死亡率（p = 0.001）之间存在显著正相关。此外，PIM3和PRISM4预测PICU收治患者死亡率的受试者工作特征（ROC）曲线下面积分别为0.939（95%CI：0.880 - 0.998）和0.660（95%CI：0.371 - 0.950）（p = 0.001）。根据研究结果，PIM3量表预测死亡率的最佳截断点为4分，PRISM4量表估计为8分。PIM3量表在4分截断点预测死亡率的敏感性和特异性分别为100.00（95%CI：56.09 - 100.00）和81.51（95%CI：75.47 - 86.38）。PRISM4模型的这些指标分别为42.85（95%CI：11.80 - 79.76）和98.10（95%CI：94.89 - 99.39），这表明PIM3系统在这方面具有更高的敏感性。
基于本研究结果，在预测入住PICU患者的院内死亡率方面，PIM3的准确性显著高于PRISM4。鉴于PIM3在预测结局方面具有100%的敏感性，该模型似乎是筛查有院内死亡风险患者的更好工具，以便给予更多关注并分配更多资源来改善其治疗结果。
