PREDICTIVE ACCURACY OF THE PRISM III SCORE FOR MORTALITY AMONG CRITICALLY ILL CHILDREN ADMITTED TO A TERTIARY CARE PAEDIATRIC INTENSIVE CARE UNIT
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Keywords
PRISM III, Paediatric mortality, PICU, Severity scoring, Critical illness, Predictive accuracy, ROC curve
Abstract
Background: Paediatric Intensive Care Units (PICUs) manage critically ill children requiring continuous monitoring and advanced life support. Mortality prediction is essential for guiding treatment decisions, optimizing scarce resources, and improving clinical outcomes. The Paediatric Risk of Mortality III (PRISM III) score is among the most validated severity-of-illness scoring systems worldwide; however, limited data exist on its performance in Indian PICUs.
Aim: To determine the predictive accuracy of PRISM III for mortality among critically ill children admitted to a tertiary care PICU.
Methods: A descriptive observational study was conducted over one year in the PICU of a tertiary care teaching hospital. One hundred critically ill children aged 1 month–14 years were enrolled. PRISM III scoring was performed within 24 hours of admission using clinical and laboratory parameters. Outcomes were recorded as discharge or death. Statistical analysis included chi-square tests, t-tests, Mann–Whitney U tests, ROC curve analysis, and diagnostic accuracy assessment using a confusion matrix.
Results: Of the 100 children studied, 81% survived and 19% died. Most patients were under 5 years (71%), with males constituting 60% of the cohort. Infectious diseases contributed the highest mortality (39.13%), with cerebral malaria (100%), pyogenic meningitis (50%), septic shock (40%), and acute encephalitis (40%) showing the highest fatality. Non-survivors had significantly lower systolic BP (49.42 vs. 75.88 mmHg), higher heart rate (216.84 vs. 174.75 bpm), higher temperature (41.08 vs. 37.92°C), and lower GCS (5.89 vs. 12.65), all p < 0.001. Ventilatory support (39%) and inotropic support (34%) were strongly associated with mortality, with all deaths occurring in ventilated patients. ROC analysis demonstrated excellent discrimination, with a PRISM III cutoff of 12 yielding 100% sensitivity, 98.77% specificity, 95% PPV, 100% NPV, and 99% accuracy.
Conclusion: PRISM III is an effective and highly accurate mortality prediction tool in critically ill children in the Indian PICU setting. Early identification of high-risk patients using PRISM III can guide timely intervention, improve triage, enhance resource allocation, and strengthen pediatric critical care outcomes.
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Dr Alok Khanna
Professor, Department of Paediatrics, Pt. BD Sharma PGIMS Rohtak, Haryana, India
Dr Sandeep
Post Graduate Student, Department of Paediatrics, Pt. BD Sharma PGIMS Rohtak, Haryana, India
Dr Neha
Associate Professor, Department of Paediatrics, Pt. BD Sharma PGIMS Rohtak, Haryana, India
Dr Jatin Prajapati
Post Graduate Student, Department of Community Medicine, RNT Medical College, Udaipur, Rajasthan, India