Abstract
Direct assessment of severity of illness would benefit many aspects of pediatric intensive care (e.q. cost containment, quality of care, therapeutic efficacies, institutional comparisons). The PSI, a direct assessment of severity of illness has been prospectively validated in 1 PICU. The PSI assesses risk of mortality by sampling 34 variables from 7 physiologic systems. However, assumptions in the PSI's development, especially the possibility of under or over measurements, require a multi-institutional validation. Participating centers collected daily PSI scores on≥200 consecutive PICU patients or for≥6 months. The observed mortality for ordered admission PSI scores was compared to the predicted mortality. The model to predict mortality was developed by logistic regression analysis predicting mortality from the organ system PSI scores and age as predictor variables (822 patients).
Results: 4 centers have completed data collection. The average mortality rates ranged from 3.0% to 12.5% (p<.01). However, when adjusted for severity of illness by admission PSI scores, the observed mortality rates for the admission PSI intervals were statistically reliably predicted by the model (X2 (3) for each center = 0.84, 2.54, 4.15, 6.36).
Conclusions: 1) The PSI is a statistically reliable predictor of mortality in all tested centers. 2) A single system is applicable to all tested centers.
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Pollack, M., Ruttimann, U., Fields, A. et al. 203 SEVERITY OF ILLNESS IN CHILDREN: MULTI NSTITUTIONAL VALIDATION OF THE PHYSIOLOGIC STABILITY INDEX (PSI). Pediatr Res 19, 144 (1985). https://doi.org/10.1203/00006450-198504000-00233
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DOI: https://doi.org/10.1203/00006450-198504000-00233
