Pediatric risk of mortality III score in predicting mortality in children with altered sensorium in pediatric intensive care unit

S. Vijayaraghavan, R. Sasivarathan


Background: The Pediatric Risk of Mortality (PRISM) Score has been devised to predict outcome and risk of mortality. The PRISM III score is one of the most recent scoring systems of pediatric mortality. This was developed involving 32 PICUs. Physiological data included the most abnormal values from the first 12 and second 12 hours of the PICU stay. To evaluate the mortality rate in children with altered sensorium by applying PRISM III (pediatric risk of mortality) score.

Methods: This study was done in the paediatric intensive care unit of the Department of Paediatrics, Government Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu, India on 100 children of both sexes aged between 1 month and 13 years. The study was carried out for a period from December 2017 to July 2018. PRISM III scoring scale was applied for every child in his/her first 24 hours of PICU admission and their calculated score was recorded into the proforma. The clinical details at admission, laboratory data were recorded into the proforma.

Results: Three major groups that contributed to the bulk of the admissions were acute CNS infection, seizure disorder and, bites and stings. They constituted to around 54% of our total admissions. As PRISM III Score increases there is a steady increase in the mortality rate. This table shows that the mortality rate is 0% for the 0-9 group and that it increases to 100% for 20-29 and 30 and above groups as the PRISM III score increase.

Conclusions: PRISM III score provides an objective assessment of the severity of illness. PRISM III, when performed well, is good to predict mortality in an Indian PICU. Scoring systems with fewer laboratory parameters will be more useful in author’s context. Larger studies are needed to develop/validate a mortality prediction score for our country.


Anatomical injury, Cardiovascular disorders, Neurological manifestation, Pediatric risk of mortality

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Apgar V. A proposal for a new method of evaluation of the newborn I infant. Anesth Analg. 1953:32:260.

Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. J Trauma. 1987;27:370.

Singhal D, Kumar N, Puliyel JM, Singh SK, Srinivas V. Prediction of mortality by application of PRISM score in intensive care unit. Indian Pediatrics. 2001;38(7):714-20.

Deerojanawong J, Prapphal N, Udomittipong K. PRISM score and factors predicting mortality of patients with respiratory failure in the pediatric intensive care unit. J Med Assoc Thai. 2001;84(1):568-75.

Fargason CA, Langman CB. Limitations of the pediatric risk of mortality score in assessing children with acute renal failure. Pediatrics Nephrol. 1993;7:703-07.

Ford EG, Andrassy RJ. Pediatric Trauma: Initial Assessment and Management. Philadelphia, WB Saunders. 1994; 112-113.

Gemke RJ, Bonsel GJ, 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(9):1477-84.

Goddard JM. Pediatric risk of mortality scoring overestimates the severity of illness in infants. Crit Care Med. 1992; 20(12):1662-5.

Kanter RK, Edge WE, Caldwell CR, Nocera MA, Orr RA. Pediatric mortality probability estimated from pre-ICU severity of illness. Pediatrics. 1997;99 (1):59-63.

Knaus WA, Zimmerman JE Wagner DP. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med. 1981;9:591.

Field MJ, Behrman RE, eds. Appendix B, Prognostication Scores: When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. Washington (DC): National Academies Press; 1988: 449-475.

Orr RA, Venkataraman ST, Cinoman MI, Hogue BL, Singleton CA, McCloskey KA. Pretransport pediatric risk of mortality (PRISM) score underestimates the requirement for intensive care or major interventions during interhospital transport. Crit Care Med. 1994;22(1):101-7.

Pollack MM, Patel KM, Ruttiman UE. PRISM III: an updated pediatric risk of mortality. Crit Care Med. 1996;24:743-52.

Proulx F, Gauthier M, Nadeau D, Lacroix J, Farrell CA. Timing and predictors of death in pediatric patients with multiple organ system failures. Crit Care Med. 1994;22:1025-31.

Tan GH, Tan TH, Goh DY, Yap HK. Risk factors for predicting mortality in a pediatric intensive care unit. Ann Acad Med Singapore. 1998;27(6):813-8.

Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2:81.

Webb A, Shapiro M, Singer M, Suter P. Oxford Textbook of Critical Care. 1st ed. United Kingdom: Oxford University Press; 1999: 45-47.

Wells M, Fanego RJF, Luyt DK, Dance M, Lipman J. Poor discriminatory performance of the pediatric risk of mortality (PRISM) scores in a South African intensive care unit. Crit Care Med. 1996;24(9):1507-13.

Yeh TS, Pollack MM, Holbrook PR. Assessment of pediatric intensive care-application of the therapeutic intervention scoring system. Crit Care Med. 1975;3:222.

Zuckerman MD, Gregory PM, Suzanne M. Predictors of death and neurological impairment in pediatric submersion injuries. Arch Pediatr Adolesc Med. 1998;152:134-40.