Pediatric Intensive Care Unit Prognostic Scoring Systems

Prognostic scoring systems in the paediatric intensive care unit (PICU) serve to quantify the severity of illness, predict mortality and support clinical decision‐making. Historically, tools such as the Paediatric Risk of Mortality (PRISM) and the Paediatric Index of Mortality (PIM) were developed to adjust for case mix when comparing outcomes across units and to guide resource allocation. The Paediatric Logistic Organ Dysfunction (PELOD) and its updated version PELOD-2 focus on the extent of organ dysfunction and offer a dynamic measure of clinical progression. Each score comprises physiological, laboratory and treatment variables recorded at admission or over a set interval. These systems underpin quality improvement, benchmarking and trials of novel therapies. They also inform family counselling and triage decisions in resource‐limited settings. Challenges include drift in calibration over time, variation in performance across age groups and underlying diagnoses, and the impact of missing or delayed data. Emerging approaches leverage machine learning to refine prediction, incorporating time-series data and novel biomarkers. International efforts aim to harmonise definitions, update models to reflect evolving case mix, and extend applicability in low-resource environments. Overall, these prognostic tools remain central to modern PICU practice, balancing simplicity, accuracy and clinical utility to improve outcomes for critically ill children.

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Pediatric Intensive Care Unit Prognostic Scoring Systems publication trend

The graph below shows the total number of articles in pediatric intensive care unit prognostic scoring systems across all publications each year (not limited to Nature Index journals).

Technical terms

PRISM (Paediatric Risk of Mortality): An aggregate score based on physiological and laboratory data recorded within the first 24 hours of PICU admission to predict mortality risk.

PIM (Paediatric Index of Mortality): A model using vital signs, diagnoses and therapeutic interventions at admission to estimate risk of death, with successive versions improving calibration.

PELOD (Paediatric Logistic Organ Dysfunction): A scoring system that quantifies the severity of organ dysfunction across multiple systems, enabling serial assessment of clinical trajectory.

Discrimination: The ability of a prognostic model to distinguish between survivors and non-survivors, often measured by area under the receiver operating characteristic curve (AUC).

Calibration: The agreement between predicted and observed outcomes across risk strata, indicating the model’s accuracy in estimating absolute risk.

Standardised Mortality Ratio (SMR): The ratio of observed deaths to those predicted by a scoring system, used to benchmark performance across units.

References

1. Daily estimation of the severity of organ dysfunctions in critically ill children by using the PELOD-2 score. Critical Care (2015).
2. Meta-Analysis for the Prediction of Mortality Rates in a Pediatric Intensive Care Unit Using Different Scores: PRISM-III/IV, PIM-3, and PELOD-2. Frontiers in Pediatrics (2021).
3. Comparison of pediatric scoring systems for mortality in septic patients and the impact of missing information on their predictive power: a retrospective analysis. PeerJ (2020).
4. Internal validation and evaluation of the predictive performance of models based on the PRISM-3 (Pediatric Risk of Mortality) and PIM-3 (Pediatric Index of Mortality) scoring systems for predicting mortality in Pediatric Intensive Care Units (PICUs). BMC Pediatrics (2022).