الفهرس 
Indications of Admission to PICUOnly 14 pages are availabe for public view
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Abstract
Pediatric intensive care unit (PICU) is an important component of tertiary pediatric care services. PICUs aim at promoting qualified care for critically ill children. Following the rapid advances in medical therapy and critical care technology over past thirty years, coupled with the spiraling cost of medical care, outcome analysis including mortality risk prediction has become a challenge for the modern day intensivists.
Scoring systems and risk prediction rules quantitate the severity of clinical conditions and stratify patients according to a specified outcome. In emergency medicine, the complexity and number of clinical scoring systems is increasing as their utility in both health services research and clinical medicine broadens.
We compare three scoring systems PRISM, PIM2 and PELOD in ability to predict mortality of admitted children in pediatric intensive care.
PRISM score composed from the following parameters (Systolic blood pressure and age, Diastolic blood pressure, Heart rate, Respiratory rate, PaO2 to FIO2 ratio, PaCO2, Glasgow coma score, Pupillary reactions to light, PT and PTT, Total serum bilirubin, Serum potassium, Serum total calcium, Glucose and Bicarbonate).
PIM2 score composed of (Systolic blood pressure in mm Hg, Pupillary reaction to light, PaO2 to FIO2 ratio, Base excess in mmol/L, Mechanical ventilation, Elective admission to the ED, Recovery after surgical procedure reason for ED admission, Cardiac bypass procedure performed, High risk diagnosis present and Low risk diagnosis present).
PELOD (Pediatric logistic organ dysfunction); a score which has been developed to estimate disease severity and evaluating critically ill children and prob-ability of death in pediatric ICUs. including six
Key organ dysfunctions (cardiovascular, respiratory, hematological, neurological, renal, hepatic) by using 12 clinical or laboratory measures. This can be used to estimate the mortality risk for the child. Follow up PELOD score was applied on day 3, day 5 and day 7.
We tested PRISM, PIM2 and PELOD scores for discrimination, calibration, and performance of mortality risks in different demographic criteria and diseases affection sub groups.
Discrimination (refers to the ability of the test to calculate a higher mortality probability among non-survivors than survivors across the whole group) both PRISM and PIM2 had good discrimination with better discrimination for PIM2. PELOD score showed acceptable discrimination
Calibration signifies how well the test predicts both mortality and survival across subcategories of risk. It was observed that, the three scores; PRISM, PIM2 and PELOD calibration performed poorly.
The significance of mortality outcome and mortality prediction by PRISM, PIM2 and PELOD in relation to different variables (age, sex, cost of hospital stay, length of stay at unit, surgical support, order of birth, referral, mechanical ventilation, underlying condition, under-nutrition and system affected), were tested, and the significant tested relations were as follow:
The p values of relation of demographic factors as order of birth, referral and hospital cost to actual outcome were insignificant but the p value of relation of length of hospital stay to actual outcome was significant (p = 0.002).
The p values of relation of clinical characteristics to actual outcome were significant for surgical support, mechanical ventilation, underlying condition and under-nutrition but they were insignificant for type of admission and consanguinity.
As regard the system affected, the performance of PIM2, PRISM and PELOD was tested in relation to the presence of system affection or not.
There is no significant relation between the system affection and prediction of mortality by PRISM, PIM2 and PELOD as P value was insignificant.
The p value of relation of outcome to the system affection was insignificant.