Desempenho do Pediatric Risk of Mortality (PRISM) e Pediatric Index of Mortality 2 (PIM2) em unidade de terapia intensiva pediátrica terciária na Amazônia brasileira

Emmerson Carlos Franco de Farias; Patrícia Barbosa de Carvalho; Luciana Maria Passos Pinto do Nascimento; Mary Lucy Ferraz Maia Fiuza de Mello; Angélica de Abreu Santana; Susan Sales Diniz; Anna Paula Santos Pinheiro; Igor Brasil Costa

doi:10.5123/S2176-6223201900080

Authors

Emmerson Carlos Franco de Farias Hospital Fundação Santa Casa de Misericórdia do Pará, Departamento Pediatria, Unidade de Terapia Intensiva Pediátrica, Belém, Pará, Brasil http://orcid.org/0000-0001-8627-5694
Patrícia Barbosa de Carvalho Hospital Fundação Santa Casa de Misericórdia do Pará, Departamento Pediatria, Unidade de Terapia Intensiva Pediátrica, Belém, Pará, Brasil http://orcid.org/0000-0001-6820-0613
Luciana Maria Passos Pinto do Nascimento Hospital Fundação Santa Casa de Misericórdia do Pará, Departamento Pediatria, Unidade de Terapia Intensiva Pediátrica, Belém, Pará, Brasil http://orcid.org/0000-0002-7880-4039
Mary Lucy Ferraz Maia Fiuza de Mello Hospital Fundação Santa Casa de Misericórdia do Pará, Departamento Pediatria, Unidade de Terapia Intensiva Pediátrica, Belém, Pará, Brasil http://orcid.org/0000-0003-4223-692X
Angélica de Abreu Santana Hospital Fundação Santa Casa de Misericórdia do Pará, Departamento Pediatria, Unidade de Terapia Intensiva Pediátrica, Belém, Pará, Brasil http://orcid.org/0000-0002-4452-7133
Susan Sales Diniz Hospital Fundação Santa Casa de Misericórdia do Pará, Departamento Pediatria, Unidade de Terapia Intensiva Pediátrica, Belém, Pará, Brasil http://orcid.org/0000-0002-5291-6403
Anna Paula Santos Pinheiro Hospital Fundação Santa Casa de Misericórdia do Pará, Departamento Pediatria, Unidade de Terapia Intensiva Pediátrica, Belém, Pará, Brasil http://orcid.org/0000-0002-2615-2809
Igor Brasil Costa Instituto Evandro Chagas, Seção de Virologia, Laboratório Epstein-Barr Vírus, Belém, Pará, Brasil http://orcid.org/0000-0003-2600-4109

DOI:

https://doi.org/10.5123/S2176-6223201900080

Keywords:

Risk Assessment, Pediatric Intensive Care Units, Prognosis, Mortality, Mortality Score

Abstract

OBJECTIVE:

To evaluate the performance of the Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality 2 (PIM2) scores in the Tertiary Pediatric Intensive Care Unit (PICU) of the Fundação Santa Casa de Misericórdia do Pará (FSCMPA).

MATERIALS AND METHODS:

A retrospective cohort study was conducted with patients hospitalized in PICU for more than 8 h, from January 2017 to April 2018. Exclusion criteria were: stay longer than 90 days; cardiorespiratory arrest without stability in 12 h; palliative care; and brain death. To calculate score and outcome systems, Standardized Mortality Rate (SMR), calibration, and discrimination variables were used and compared by goodness-of-fit and Receiver Operating Characteristic (ROC) curves, respectively.

RESULTS:

Among the 458 hospitalizations, 429 (93.7%) were included. Overall mortality was 17.5%, with 64.0% under 2 years of age; and 58.7% of those who evolved to death were submitted to mechanical ventilation for more than seven days. The estimated mean probability of death from PRISM was 9.85%, while the mean PIM2 was 14.2%. The SMR was 1.35 (1.26-1.72) for PRISM and 1.23 (1.13-1.58) for PIM2. The area under the ROC curve was 0.89 (95% CI 0.81-0.91) for PRISM and 0.87 (95% CI 0.83-0.91) for PIM2.

CONCLUSION:

In the FSCMPA PICU, PRISM and PIM2 had good calibration and good discriminatory power. The SMR was greater than one.