Abstract
Background: Accurate mortality prediction in pediatric intensive care units (PICUs) is critical for clinical decision-making, benchmarking, and guiding resource allocation. While the Pediatric Risk of Mortality (PRISM) score is widely used in children, the Acute Physiology and Chronic Health Evaluation II (APACHE II), originally developed for adults, is occasionally applied in pediatric settings despite limited validation.
Objective: To compare the predictive performance of PRISM and APACHE II scores in critically ill children admitted to a tertiary PICU in Pakistan.
Methods: We conducted a retrospective cohort study of 214 patients aged 0–18 years admitted to the PICU of Lahore General Hospital over six months. PRISM and APACHE II scores were calculated within the first 24 hours of admission. Discrimination was assessed using area under the receiver operating characteristic curve (AUC), and calibration was evaluated with the Hosmer–Lemeshow test, Brier score, and error analyses.
Results: Neither PRISM (AUC = 0.656) nor APACHE II (AUC = 0.587) achieved strong discriminatory power, and differences between the two models were not statistically significant (p = 0.388). Calibration was acceptable for both models, with marginally better performance for PRISM. However, neither score independently predicted mortality in multivariate regression analyses.
Conclusion: In this large South Asian cohort, PRISM outperformed APACHE II but both scores demonstrated limited predictive accuracy. These findings highlight the limitations of applying adult-derived indices to pediatric patients and reinforce the need for pediatric-specific, locally validated prognostic tools. Our results provide important regional evidence and underscore the urgency of multicenter efforts to develop robust, resource-appropriate models for global pediatric critical care.
Keywords
Pediatrics, Intensive care units, Pediatric, Mortality, Severity of illness index, Prognosis