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Türkiye’de Pediatrik Yoğun Bakım Ünitesi’nde Pediatric Index of Mortality 2 (PIM2) ve Pediatric Risk of Mortality (PRISM) Skorlarının Uygunluğunun Değerlendirilmesi

Year 2018, Volume: 12 Issue: 1, 1 - 5, 01.04.2018

Yeşim Oymak Benan Bayrakçı

Abstract

Amaç: Çocuk yoğun bakım ünitelerinde (ÇYBÜ) son derece teknolojik kurulumlara ihtiyaç bulunmaktadır. Gelişmiş teknolojiye ek olarak bu birimlerdeki hizmeti standart hale getirmek üzere mortalite skorlama sistemlerine ihtiyaç olmaktadır. Pediatric Index of Mortality (PIM) ve Pediatric Risk of Mortality (PRISM) skorlamaları en iyi mortalite tahmin skorlarıdır. Çalışmanın amacı, ileri merkezlerde geliştirilmiş olan skorlamaların etkinliklerini kıyaslayarak aralarından ünitemiz için en uygun olanını seçmek ve bu skorlama sistemini yoğun bakım ünitemize yerleştirmektir.Gereç ve Yöntemler: Bir yıl içinde ÇYBÜ’e yapılan 389 yatış çalışmaya dahil edildi. PIM2, PRISM skorlamaları prospektif olarak hesaplandı. Bu skorlamaların ayırt ettirici özellikleri istatistiksel olarak ROC (Receiver Operating Characteristics) eğrisi altında kalan alan hesaplanarak değerlendirildi. Skorlamaların ünitemize uygunluğu Hosmer ve Lemeshow tarafından geliştirilen Goodness-of-fit testi ile değerlendirildi. Her üç skorlama için de p değeri 0.05 alındı. Standardize edilmiş mortalite oranı (SMR) hesaplandı.Bulgular: PIM2, PRISM-12 ve 24 için sırayla 0.84, 0.86 ve 0.89 bulundu. ROC eğrisi altında kalan alanın 0.80’nin üzerinde olması nedeniyle her üç skorlama sisteminin de iyi ayırt ettirici özellikte olduğu görüldü. Her üç skorlama için SMR 1’in altında bulundu.Sonuç: Bu sonuçlar merkezimizde gözlenen mortalitenin beklenen mortaliteden daha düşük olduğunu gösterdi. Sonuç olarak bu skorlamaların ünitemiz için mortaliteyi öngörmede ayırt ettirici olduğu ancak kalibrasyonlarının yeterli olmadığı görüldü.

Keywords

Çocuk yoğun bakım ünitesi Hastane mortalitesi

References

  • Teres D, Lemeshow S. Using severity measures to describe high performance intensive care units. Crit Care Clin 1993;9:543-54.
  • Pollack MM, Ruttiman UE, Getson PR. Pediatric Risk of Mortality (PRISM) score. Crit Care Med 1988; 16:1110-6.
  • Shann F, Pearson G, Slater A. Pediatric Index of Mortality (PIM): A mortality prediction model for children in intensive care. Intensive Care Med 1997; 23:201–7.
  • Pollack MM, Patel KM, Ruttimann UE. The Pediatric Risk of Mortality III-Acute Physiology Score (PRISM III-APS): A method of assessing physiologic instability for pediatric intensive care unit patients. J Pediatr 1997;131:575–81.
  • Hosmer D, Lemeshow S. Applied logistic regression. 2nd ed. New York: Wiley, 2000.
  • Taori RN, Lahiri KR, Tullu MS. Performance of PRISM (Pediatric Risk of Mortality) score and PIM (Pediatric Index of Mortality) score in a tertiary care pediatric ICU. Indian J Pediatr 2010;77:267-71.
  • Gonçalves JP, Severo M, Rocha C, Jardim J, Mota T, Ribeiro A. Performance of PRISM III and PELOD-2 scores in a pediatric intensive care unit. Eur J Pediatr 2015;174:1305-10.
  • Thukral A, Lodha R, Irshad M, Arora NK. Performance of Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality (PIM), and PIM2 in a pediatric intensive care unit in a developing country. Pediatr Crit Care Med 2006;7:356–61.
  • Te CT. Introductory Biostatistics, New Jersey: Wiley-Interscience, 2003.
  • Pollack MM, Patel KM, Ruttimann UE. PRISM III: An updated pediatric risk of mortality score. Crit Care Med 1996;24:743-52.
  • Slater A, Shann F. The suitability of the Pediatric Index of Mortality (PIM), PIM2, the Pediatric Risk of Mortality (PRISM), and PRISM III for monitoring the quality of pediatric intensive care in Australia and New Zealand. Pediatr Crit Care Med 2004; 5:447–54.
  • KMS C, DKK N, Wong SF. Assessment of the Pediatric Index of Mortality (PIM) and the Pediatric Risk of Mortality (PRISM) III score for prediction of mortality in a paediatric intensive care unit in Hong Kong. Hong Kong Med J 2005;11:97–103.
  • Gemke RJ, Bonsel GJ, Van Vught AJ. Effectiveness and efficiency of a Dutch pediatric intensive care unit: Validity and application of the Pediatric Risk of Mortality score. Crit Care Med 1994;22:1477– 84.
  • Leteurtre S, Leclerc F, Wirth J. Can generic paediatric mortality scores calculated 4 hours after admission be used as inclusion criteria for clinical trials? Crit Care 2004;8:185–93.
  • Brady AR, Harrison D, Black S. Assessment and optimization of mortality prediction tools for admissions to pediatric intensive care in the United Kingdom. Pediatrics 2006;117:733–42.

The Suitability of Pediatric Index of Mortality 2 (PIM2) and Pediatric Risk of Mortality (PRISM) for Pediatric Intensive Care in Turkey

Year 2018, Volume: 12 Issue: 1, 1 - 5, 01.04.2018

Yeşim Oymak Benan Bayrakçı

Abstract

Objective: There is a need for a highly technological setting in pediatric intensive care units. In addition to advanced technology, mortality scoring systems are necessary to standardize the care given in these units. Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality (PIM) are the best known mortality prediction scores. The aim of this study was to determine and validate the scoring systems’ effectiveness in order to choose the most suitable one and put it in regular practice in our unit. We included the three hundred eighty nine admissions to the PICU within one year in the study. Material and Methods: Mortality scores for PIM2 and PRISM were calculated prospectively. Discriminatory performance was assessed with the Receiver Operating Curve (ROC). Statistical analysis for calibration of the scoring systems was carried out using the Hosmer and Lemeshow goodness-of-fit test. P values were < 0.05 for all scoring systems. Standardized mortality rates (SMR) were also calculated.Results: All three scoring systems exhibited good discrimination with area under the curve values of 0.84, 0.86 and 0.89 for PIM2, PRISM12 and PRISM24 respectively. SMRs were less than 1.0 for all scoring systems. Conclusion: This result showed that mortality was lower than that expected for our unit indicating that these scoring systems have good discriminatory performance, but their calibrations were poor for our unit

Keywords

Pediatric intensive care unit Hospital mortality

References

  • Teres D, Lemeshow S. Using severity measures to describe high performance intensive care units. Crit Care Clin 1993;9:543-54.
  • Pollack MM, Ruttiman UE, Getson PR. Pediatric Risk of Mortality (PRISM) score. Crit Care Med 1988; 16:1110-6.
  • Shann F, Pearson G, Slater A. Pediatric Index of Mortality (PIM): A mortality prediction model for children in intensive care. Intensive Care Med 1997; 23:201–7.
  • Pollack MM, Patel KM, Ruttimann UE. The Pediatric Risk of Mortality III-Acute Physiology Score (PRISM III-APS): A method of assessing physiologic instability for pediatric intensive care unit patients. J Pediatr 1997;131:575–81.
  • Hosmer D, Lemeshow S. Applied logistic regression. 2nd ed. New York: Wiley, 2000.
  • Taori RN, Lahiri KR, Tullu MS. Performance of PRISM (Pediatric Risk of Mortality) score and PIM (Pediatric Index of Mortality) score in a tertiary care pediatric ICU. Indian J Pediatr 2010;77:267-71.
  • Gonçalves JP, Severo M, Rocha C, Jardim J, Mota T, Ribeiro A. Performance of PRISM III and PELOD-2 scores in a pediatric intensive care unit. Eur J Pediatr 2015;174:1305-10.
  • Thukral A, Lodha R, Irshad M, Arora NK. Performance of Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality (PIM), and PIM2 in a pediatric intensive care unit in a developing country. Pediatr Crit Care Med 2006;7:356–61.
  • Te CT. Introductory Biostatistics, New Jersey: Wiley-Interscience, 2003.
  • Pollack MM, Patel KM, Ruttimann UE. PRISM III: An updated pediatric risk of mortality score. Crit Care Med 1996;24:743-52.
  • Slater A, Shann F. The suitability of the Pediatric Index of Mortality (PIM), PIM2, the Pediatric Risk of Mortality (PRISM), and PRISM III for monitoring the quality of pediatric intensive care in Australia and New Zealand. Pediatr Crit Care Med 2004; 5:447–54.
  • KMS C, DKK N, Wong SF. Assessment of the Pediatric Index of Mortality (PIM) and the Pediatric Risk of Mortality (PRISM) III score for prediction of mortality in a paediatric intensive care unit in Hong Kong. Hong Kong Med J 2005;11:97–103.
  • Gemke RJ, Bonsel GJ, Van Vught AJ. Effectiveness and efficiency of a Dutch pediatric intensive care unit: Validity and application of the Pediatric Risk of Mortality score. Crit Care Med 1994;22:1477– 84.
  • Leteurtre S, Leclerc F, Wirth J. Can generic paediatric mortality scores calculated 4 hours after admission be used as inclusion criteria for clinical trials? Crit Care 2004;8:185–93.
  • Brady AR, Harrison D, Black S. Assessment and optimization of mortality prediction tools for admissions to pediatric intensive care in the United Kingdom. Pediatrics 2006;117:733–42.
There are 15 citations in total.

Details

Other ID JA69UP56YC
Journal Section Research Article
Authors

Yeşim Oymak This is me

Benan Bayrakçı This is me

Publication Date April 1, 2018
Submission Date April 1, 2018
Published in Issue Year 2018 Volume: 12 Issue: 1

Cite

Vancouver Oymak Y, Bayrakçı B. The Suitability of Pediatric Index of Mortality 2 (PIM2) and Pediatric Risk of Mortality (PRISM) for Pediatric Intensive Care in Turkey. Türkiye Çocuk Hast Derg. 2018;12(1):1-5.


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