Performance of PIM, PRISM, and PELOD scores in a resource-limited North Indian paediatric intensive care unit

Table 1 Demographic and clinical characteristics of patients, median (interquartile range)/n (%)

Characteristics	Total, n = 175	Survivors, n = 151	Non-survivors, n = 24	P value
Age in months	48 (12-126)	42 (12-132)	54 (4.7-102)	0.845
Age subgroups
1-12 months	56	49 (87.5)	7 (12.5)	0.686
13-60 months	46	40 (87)	6 (13)
61-120 months	29	23 (79.3)	6 (20.7)
> 120 months	44	39 (88.6)	5 (11.4)
Gender
Male	96	85 (88.5)	11 (11.5)	0.339
Female	79	66 (83.5)	13 (16.5)
Primary diagnosis
Respiratory disease	41	41 (100.0)	0	0.372
Renal disease	2	2 (100.0)	0
Sepsis	30	15 (50.0)	15 (50.0)
Neurological disease	43	41 (95.2)	2 (4.7)
Cardiac disease	10	10 (100.0)	0
Postoperative	1	1 (100.0)	0
Oncology	8	6 (75.0)	2 (25.0)
Trauma	2	1 (50.0)	1 (50.0)
Endocrine	4	0	4 (100.0)
Hepatic disease	6	4 (66.7)	2 (33.3)
Poisoning	9	9 (100.0)	0
Metabolic disease	1	0	1 (100.0)
Gastrointestinal disease	18	17 (94.4)	1 (5.6)
Mechanical ventilation in first 24 hours	25	9 (36)	16 (64)	< 0.001
Inotropes in first 24 hours	26	14 (53.8)	12 (46.2)	< 0.001
Duration of PICU stay (days)	3 (1-5)	3 (1-4)	4 (2-7)	0.031
Duration of total hospital stay (days)	5 (4-9)	6 (4-9)	4 (2-7)	0.011
Referred out	13	7 (53.8)	6 (46.2)	0.231

PICU: Paediatric intensive care unit.

Table 2 Comparison of pediatric risk of mortality score III, pediatric index of mortality-3, and pediatric logistic organ dysfunction score-2 mortality scores between survivors and non-survivors, mean ± SD/median (interquartile range)

	Survivors, n = 151	Non survivors, n = 24	Total, n = 175	P value	AUROC (95%CI)	Observed death (O)	Expected death (E)	SMR (O/E) 95%CI	Calibration HL-GOF
PRISM-III	4.35 ± 3.92	13.04 ± 7.68	5.54 ± 5.55	< 0.001	0.884 (0.827-0.927)	24	23	1.04 (0.63-0.46)	χ2 = 2.69, P = 0.952
	3 (2-6)	10.5 (6-18)	4 (2-7)
PIM-3	2.52 ± 1.75	18.79 ± 28.31	4.75 ± 1.84	< 0.001	0.951 (0.907-0.978)	24	24	1.0 (0.64-1.47)	χ2 = 5.592, P = 0.692
	2.1 (1.6-2.8)	8.6 (4-13.5)	2.3 (1.7-3.5)
PELOD-2	1.74 ± 2.08	7.08 ± 4.20	2.47 ± 3.07	< 0.001	0.939 (0.893-0.970)	24	23	1.04 (0.63-1.46)	χ2 = 7.36, P = 0.518
	2 (0-2)	7 (4-9)	2 (0.6-3)

HL-GOF: Hosmer-Lemeshow goodness of fit; AUROC: Area under the receiver operating characteristic curve; CI: Confidence interval; SMR: Standardized mortality ratio; PELOD-2: Pediatric logistic organ dysfunction score-2; PRISM-III: Pediatric risk of mortality score III; PIM-3: Pediatric index of mortality-3.

Table 3 Age-stratified predictive performance of pediatric risk of mortality score III, pediatric index of mortality-3, and pediatric logistic organ dysfunction score-2 mortality scores

	PRISM-III	PIM-3	PELOD-2
Age group 1-12 months
mean ± SD	4.52 ± 5.48	4.85 ± 11.70	2.64 ± 2.75
median (interquartile range)	3 (1.5-6)	2.6 (1.9-3.1)	2 (2-3)
AUROC (95%CI)	0.856 (0.656-1.000)	0.845 (0.550-1.000)	0.883 (0.722-0.990)
Observed death (O)	7	7	7
Expected death (E)	7	6	7
SMR (O/E) 95%CI	1	1.2	1
HL χ2	1.55	7.07	1.72
P value	0.907	0.53	0.423
Age group 13-60 months
mean ± SD	5.61 ± 5.61	5.19 ± 13.74	2.26 ± 3.30
median (interquartile range)	4 (2.2-6.8)	2.3 (1.8-3.7)	1.5 (0-2)
AUROC (95%CI)	0.872 (0.701-1.000)	0.976 (0.925-1.000)	0.982 (0.938-1.000)
Observed death (O)	6	6	6
Expected death (E)	5	6	6
SMR (O/E) 95%CI	1.2	1	1
HL χ2	5.84	2.58	6.14
P value	0.441	0.958	0.105
Age group 61-120 months
mean ± SD	6.97 ± 6.20	2.87 ± 2.57	3.14 ± 3.69
median (interquartile range)	5 (2-10)	2.1 (1.4-3.7)	2 (0-6)
AUROC (95%CI)	0.812 (0.635-0.953)	0.884 (0.718-1.000)	0.783 (0.530-0.971)
Observed death (O)	6	6	6
Expected death (E)	6	5	6
SMR (O/E) 95%CI	1	1.2	1
HL χ2	7.65	12.06	4.17
P value	0.468	0.149	0.383
Age group > 120 months
mean ± SD	5.93 ± 5.06	5.41 ± 13.68	2.05 ± 2.77
median (interquartile range)	5 (2-7)	2.05 (1.6-3.55)	1 (0-3)
AUROC (95%CI)	0.849 (0.640-1.000)	0.764 (0.333-1.000)	0.879 (0.660-1.000)
Observed death (O)	5	5	5
Expected death (E)	5	4	5
SMR (O/E) 95%CI	1	1.3	1
HL χ2	10.06	8.99	4.02
P value	0.185	0.343	0.546

PELOD-2: Pediatric logistic organ dysfunction score-2; PRISM-III: Pediatric risk of mortality score III; PIM-3: Pediatric index of mortality-3; HL: Hosmer-Lemeshow; AUROC: Area under the receiver operating characteristic curve; CI: Confidence interval; SMR: Standardized mortality ratio.

Table 4 Diagnostic accuracy of pediatric risk of mortality score III, pediatric index of mortality-3, and pediatric logistic organ dysfunction score-2 mortality scores

		Mortality		Total, 175	Sensitivity, %	Specificity, %	PPV, %	NPV, %	Diagnostic accuracy
		Yes, 24	No, 151
PRISM-III	> 6	17	33	50	70.8	78.1	34	95.4	77.1
	≤ 6	7	118	125
PIM-3	> 3.6	19	23	42	79.2	84.8	45.2	96.2	84
	≤ 3.6	5	128	133
PELOD-2	> 3.8	21	29	50	87.5	80.8	42	97.6	81.7
	≤ 3.8	3	122	125

PELOD-2: Pediatric logistic organ dysfunction score-2; PRISM-III: Pediatric risk of mortality score III; PIM-3: Pediatric index of mortality-3; PPV: Positive predictive value; NPV: Negative predictive value.