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Abstract Background Paediatric intensive care units (PICU) experience a big challenge with malnutrition. It significantly impacts the development and prognosis of critically ill patients (CIP). CIP are those who require high reliance or serious medical and/or surgical interventions. For their importance, valid and reliable nutritional markers are mandatory to be implemented in the daily practice of our PICU. The aim of this study was to determine the nutritional status of CIP in PICU through measuring prealbumin level and use it as predictor of malnutrition and clinical outcome. Methods Forty four CIP admitted to the Children's Hospital, Cairo University PICU, throughout six months were the subject of this cross-sectional study. Clinical nutritional status was evaluated using the Z-score, and prealbumin level was measured. Results 50% of children who were critically sick also had malnutrition, with severe malnutrition accounting for the majority of cases (34.1%). Prealbumin did not significantly correlate with malnutrition, nor the mortality in CIP. However, malnutrition is strongly linked to mortality in critically ill children. To predict malnutrition in CIP, serum prealbumin at cutoff > 163.64 exhibited AUC of 0.556 with sensitivity of 90.91% and a specificity of 31.82%. For prediction of the clinical outcome, serum prealbumin at cutoff ≤ 758.37 had an AUC of 0.535 with a sensitivity of 91.67% and a specificity of 21.87%. Conclusions Malnutrition significantly increased the risk of death. Prealbumin was neither a significant predictor for malnutrition nor mortality in CIP.

Background: Paediatric intensive care units (PICU) experience a big challenge with malnutrition. It significantly impacts the development and prognosis of critically ill patients (CIP). CIP are those who require high reliance or serious medical and/or surgical interventions. For their importance, valid and reliable nutritional markers are mandatory to be implemented in the daily practice of our PICU. The aim of this study was to determine the nutritional status of CIP in PICU through measuring prealbumin level and use it as predictor of malnutrition and clinical outcome. Methods: Forty four CIP admitted to the Children's Hospital, Cairo University PICU, throughout six months were the subject of this cross-sectional study. Clinical nutritional status was evaluated using the Z-score, and prealbumin level was measured. Results: 50% of children who were critically sick also had malnutrition, with severe malnutrition accounting for the majority of cases (34.1%). Prealbumin did not significantly correlate with malnutrition, nor the mortality in CIP. However, malnutrition is strongly linked to mortality in critically ill children. To predict malnutrition in CIP, serum prealbumin at cutoff > 163.64 exhibited AUC of 0.556 with sensitivity of 90.91% and a specificity of 31.82%. For prediction of the clinical outcome, serum prealbumin at cutoff ≤ 758.37 had an AUC of 0.535 with a sensitivity of 91.67% and a specificity of 21.87%. Conclusions: Malnutrition significantly increased the risk of death. Prealbumin was neither a significant predictor for malnutrition nor mortality in CIP. [ABSTRACT FROM AUTHOR]

Background: The pediatric risk of mortality (PRISM) score predicts mortality in the pediatric intensive care unit (PICU). This study aimed to evaluate the application of PRISM score as a predictor of mortality in intensive care units of a tertiary hospital. Methodology: A descriptive cross-sectional study of one year was conducted within the Department of Pediatrics at Ziauddin University and Hospital, located in Karachi, Pakistan. The total number of 263 admitted neonates and children up to the age of 12 years were included. Patients more than 12 years of age admitted in wards and plane for any surgery were excluded from the study; the PRISM score tool was used to collect the data of the neonates and children. Results: The mean PRISM score was high among non-survivors (15.3 ± 7.2) as compared to survivors (12.7 ± 9.2) (p=0.023). The predictability of the PRISM score regarding pediatric mortality was shown by the area under the curve (AUC) i.e., 0.636. Conclusion: The PRISM score found a significant difference between survival and death groups. Therefore the implication of the PRISM score can be needed in PICU to reduce the mortality rate.

Objective: To assess the application and efficacy of PRISM score in predicting mortality rate in a tertiary care PICU of a developing country. Study Design: Prospective cohort study. Place and Duration of Study: This study was carried out at Pediatric Department, Pak Emirates Military Hospital Rawalpindi, from Mar 2017 to Aug 2017. Material and Methods: In this study 370 consecutive admissions as per the inclusion criteria were enrolled. PRISM score was calculated as recommended by original authors and outcome for each patient was recorded as expired or discharged. Hosmer-Lemeshow goodness-of-fit test and Area under the ROC Curve were used to ascertain the power of calibration and discrimination of the score. Results: Out of the 370 patients with a mean age of 19 months, 282 (76.2%) survived and 88 cases expired (23.8%). Male to Female ratio was 1.56:1 and the majority of patients were infants (225/370). Infants recorded highest mortality percentage (24%). Infectious diseases were the most common etiology. There was no association of gender with outcome however length of stay had a positive correlation with survival. Mean PRISM score was 14.0 with scores significantly lower in survivors (p

Objective: To assess the application and efficacy of PRISM score in predicting mortality rate in a tertiary care PICU of a developing country. Study Design: Prospective cohort study. Place and Duration of Study: This study was carried out at Pediatric Department, Pak Emirates Military Hospital Rawalpindi, from Mar 2017 to Aug 2017. Material and Methods: In this study 370 consecutive admissions as per the inclusion criteria were enrolled. PRISM score was calculated as recommended by original authors and outcome for each patient was recorded as expired or discharged. Hosmer-Lemeshow goodness-of-fit test and Area under the ROC Curve were used to ascertain the power of calibration and discrimination of the score. Results: Out of the 370 patients with a mean age of 19 months, 282 (76.2%) survived and 88 cases expired (23.8%). Male to Female ratio was 1.56:1 and the majority of patients were infants (225/370). Infants recorded highest mortality percentage (24%). Infectious diseases were the most common etiology. There was no association of gender with outcome however length of stay had a positive correlation with survival. Mean PRISM score was 14.0 with scores significantly lower in survivors (p<0.001). Pearson Chi-square revealed significant association between PRISM score categories and child outcome. Hosmer & Lemeshow statistic was non-significant (p=0.244) at 10.30, revealing an acceptable goodness of fit of the regression model. Area under ROC curve was .885 indicating good predicting power of the model. Conclusion: PRISM score showed good discriminatory capacity and was found to be a useful tool for predicting prognosis of pediatric patients admitted to a tertiary pediatric intensive care unit in resource constrained developing countries. [ABSTRACT FROM AUTHOR]

Background: Since decades there has been growth in pediatric critical care hence there is a need to have a standard way of assessing severity of illness and the risk of mortality. PRISM score is based on the physiological derangement by disease process which is determined within 24 hrs of admission and includes 14 variables including clinical and laboratory measures. The score has been found to have good assessment of the risk of mortality Aims: to determine the relationship between mortality & different PRISM scores. The present study aims at PICU admissions with sample size of 100. Methodology: An observational prospective study was carried out at a tertiary care center in Moradabad Uttar Pradesh targeting children aged 1 month to 12 years in PICU. A thorough and focused clinical examination was done and blood samples were drawn within 24 hrs of admission to assess the PRISM score variables. Results: A total of 100 children between 6months to 12 years with a median of 10 months were enrolled into the study between the months of January 2018 and march 2018. 90% deaths were noted with score more than 39 as compared to 35% with PRISM score of 20-29. Conclusion- there is increased in number of deaths score with increasing PRISM score.

The pediatric risk of mortality (PRISM) score is a measure of illness severity based on abnormalities observed on bedside examination and laboratory assessment at pediatric Intensive care Unit (PICU) admission to predict mortality probability. Our study was performed on 205 patients who were admitted to PICU of children’s Medical center (CMC) over a period of 6 months.Data were recorded prospectively from observations at the time of admission in PICU and PRISM score was measured at admission (PRISMa) and after 24 hours (PRISMI). The mortality probability raised from 0 at low scores, approaching 1 above a PRISM score of near 40. Based on PRISMa score of 11.36, (cut-off point), patients were divided in two groups; 71% with low risk of mortaligy, who had significant difference in length of stay in ICU, admission costs and mortality rates. Other variables such as referring from other centers, mechanical ventilation at admission, and length of stay in ICU had s significant statistical relation with mortality rate.For data obtained, observed mortality rates were near similar to predicted. Athough pre-ICU PRISM score cannot be used as a single certain predictive value, but it is useful in predicting severity of illness and mortality probablitiy. Further investigations is required to determine the effectiveness of PRISM scores in our country

Objective: To find the appropriate type of intravenous fluid (isotonic vs. hypotonic saline in 5 % dextrose) for empiric maintenance fluid therapy in children with central nervous system (CNS) infections that reduces the incidence of hospital acquired hyponatremia. Methods: This blinded randomized controlled trial included hospitalized children aged 3 mo to 5 y with suspected CNS infections requiring intravenous maintenance fluid for at least 24 h. The subjects were randomized to receive 0.9 % saline (Group-A), 0.45 % saline (Group-B) and 0.18 % saline (Group-C) at standard maintenance rate. The outcome measures were proportion of patients developing hyponatremia (serum sodium < 135 mmol/L) after 24 h and serum sodium values at 6, 12, 18, 24 h of receiving maintenance fluids. Results: Of the 92 patients enroled, 31, 30 and 31 patients were randomized to Group A, B and C, respectively. Majority (60.7 %) of the patients in Group-C developed hyponatremia compared with 7.1 % of the children in Group-A and 46.1 % in Group-B. During first 24 h of fluid administration successive fall in the serum sodium values was observed in patients receiving hypotonic fluids. The risk of developing hyponatremia was nearly 6½ (95 % confidence interval (CI) 1.6-26) to 8.5 (95 % CI 2.16-33.39) times more in patients who received hypotonic saline compared to those who received isotonic saline. Conclusions: Administration of 0.9 % saline in 5 % dextrose as intravenous maintenance fluid in children with CNS infection leads to significantly less incidence of hyponatremia when compared to that with hypotonic fluids. [ABSTRACT FROM AUTHOR]

Objective: The Pediatric Risk of Mortality (PRISM) score is one of the scores used by many pediatricians for prediction of the mortality risk in the pediatric intensive care unit (PICU). Herein, we intend to evaluate the efficacy of PRISM score in prediction of mortality rate in PICU. Methods: In this cohort study, 221 children admitted during an 18-month period to PICU, were enrolled. PRISM score and mortality risk were calculated. Follow up was noted as death or discharge. Results were analyzed by Kaplan-Meier curve, ROC curve, Log Rank (Mantel-Cox), Logistic regression model using SPSS 15. Findings: Totally, 57% of the patients were males. Forty seven patients died during the study period. The PRISM score was 0-10 in 71%, 11-20 in 20.4% and 21-30 in 8.6%. PRISM score showed an increase of mortality from 10.2% in 0-10 score patients to 73.8% in 21-30 score ones. The survival time significantly decreased as PRISM score increased (P≤0.001). A 7.2 fold mortality risk was present in patients with score 21-30 compared with score 0-10. ROC curve analysis for mortality according to PRISM score showed an under curve area of 80.3%. Conclusion: PRISM score is a good predictor for evaluation of mortality risk in PICU. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the use of the PRISM score as a predictor of outcome in patients with end stage liver disease (ESLD) and fulminant hepatic failure (FHF). Methods: The present study included 30 patients with ESLD and FHF, with ages ranging from 2 to 108 months, who were admitted to the Emergency room (ER) and the Pediatric Hepatology Unit at Cairo University Children's Hospital (tertiary referral hospital) over a six-month-period from May through October 2008. Survivors were followed up for 6 months. Two other scores were also calculated, the PELD score and the Child-Pugh score. The outcome was defined as survivors and deceased. Results: Deceased patients as compared with survivors were significantly younger (median age 7 vs. 24 months, p = 0.003). A ROC curve was constructed for the PRISM score, the predicted death rate (PDR) and the PELD score in the 30 patients. PRISM score was significantly associated with mortality ( p = 0.04). The best cut off value was 9.5 (70.6% sensitive and 61% specific). PDR was also significantly associated with mortality ( p = 0.011). The best cut off value for PDR was 5.95 (70.6% sensitive, 85% specific). On the other hand, the PELD score was not associated with mortality ( p = 0.202). Conclusions: PRISM score can be applied with an adequate degree of accuracy for severity assessment and mortality prediction to pediatric patients with ESLD or FHF. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this retrospective descriptive study was to describe both epidemiologically and clinically manifestations following severe scorpion envenomation and to define simple predictive factors which can be used in routine practice in general Intensive Care Units (ICU) as an indicator of poor prognosis. Cases were collected from hospital patients'' files during 13-year (1990–2002) period in the medical Intensive Care Unit of a university hospital (Sfax – Tunisia). The diagnosis of scorpion envenomation was based on a history of scorpion sting. Nine hundred fifty-one patients, who were admitted for a scorpion sting, were analyzed. There were 769 patients (80.8%) in the grade III group (with cardiogenic shock and/or pulmonary edema or severe neurological manifestation (coma and/or convulsion)) and 182 patients (19.2%) in the grade II group (with systemic manifestations). Scorpion envenomation is more frequent in summer; indeed 82.3% of our patients were admitted between June and September. The mean age (±SD) was 14.7 ± 17.4 years, ranging from 0.5 to 90 years. In this study 739 patients (77.8%) had neuromuscular signs, 700 patients (73.6%) had gastrointestinal signs and 585 patients (61.5%) had a pulmonary edema, while 195 patients (20.5%) had a cardiogenic shock. The mean blood sugar on admission was at 11.32 ± 5.66 mmol/l, a high blood sugar level (>11 mmol/l) was observed in 39% of cases. The mean blood urea was at 7.1 ± 3.2 mmol/l, it was above 10 mmol/l in 10.7% of cases. The mean of leucocytes was at 17 418 ± 7833 cells/mm3, it was above 11 000/mm3 in 80% of cases. In the end of the stay in ICU, evolution was marked by the improvement of 879 patients (92.5%) while 72 patients (7.5%) died. A multivariate analysis found the following factors to be correlated with a poor outcome: age less than 5 years (OR = 2.27), fever >38.5 °C (OR = 2.79), coma with Glasgow coma score ≤8/15 (OR = 9.87), pulmonary edema (OR = 8.46), leucocytes >25 000 cells/mm3 (OR = 2.35) and blood urea >8 mmol/l (OR = 4.02). Moreover, in children group, a significant association was found between PRISM score and mortality rate, this model had a high discriminative power with an area under the ROC curve at 0.93. In the adult patients a significant association was found between SAPS II score and mortality rate, this model had a high discriminative power with an area under the ROC curve at 0.82. In summary, in severe scorpion envenomation, age less than 5 years, fever >38.5 °C, coma with Glasgow coma score ≤8/15, pulmonary edema, leucocytes >25 000 cells/mm3 and blood urea >8 mmol/l were associated with a poor outcome. [Copyright &y& Elsevier]

Background: Signs of Inflammation in Children that can Kill (SICK score) is a new severity-of-illness score. It uses the physical signs of the Systemic Inflammatory Response Syndrome (SIRS) and its continuum - the Multiple Organ Dysfunction Syndrome (MODS). The development of the score used multiple logistic regression model coefficients converted to integer scores that have been published earlier. Aims: The present study was done to validate the scoring system by predicting outcomes in a fresh data set. Setting: Intensive care unit in a tertiary referral hospital Design: Prospective Materials and Methods: 125 admissions to the intensive care unit were evaluated so that the SICK score and the PRISM score could be calculated. In-hospital mortality was noted Statistical Analysis: Calibration (Hosmer-Lemeshow goodness of fit) and discrimination (area under the ROC curve) were used to measure performance. Results: Of the 125 patients studied 23 died. The area under the ROC curve was 0.76 compared to 0.80 in the development sample. Using PRISM in the validation group, the ROC was 0.78. Calibration was excellent. Conclusion: The SICK score can predict severity of illness with nearly the same accuracy as the PRISM score. The SICK score can be calculated immediately on admission and can help to prioritize care for the more sick children who need urgent aggressive management. Larger studies, that includes all admissions to the hospital, will now need to be done. [ABSTRACT FROM AUTHOR]

Abstract: The pediatric risk of mortality (PRISM) score as a severity scoring system has never been assessed in infants and children with fulminant liver failure (FLF). A retrospective case study of 109 infants and children admitted in a 22-bed pediatric and neonatal intensive care unit of a tertiary university hospital, National Referral Center for Pediatric Liver Transplantation, from March 1986 to August 1997 was carried out. PRISM score was not significantly different within etiologic FLF categories, or between infants and children. However, PRISM score (mean ± SD) showed significant difference (p = 0.001) between the 27 patients who spontaneously recovered with supportive care (8.8 ± 5.0) and 82 patients who underwent emergency liver transplantation (ELT) or those who died before (14.9 ± 7.7). PRISM score-based probability of mortality was underestimated when compared with observed mortality. A death probability higher than 20% had a 24% sensitivity and 95% specificity for severe outcome. Reciever operating characteristic curve for PRISM score showed elevated discriminative power (Az = 0.91) for discerning children with severe outcome from those who spontaneously recovered with supportive care. A PRISM score more than 10 showed an odds ratio of 2.69 for predicting severe outcome (95% CI: 1.11–6.55; p = 0.038). In conclusion, the PRISM score is an accurate means of severity assessment in pediatric FLF. However, PRISM score-based mortality was of low predictive value. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the predicted mortality rate of oncologic patients in the PICU using the PRISM score and factors that might influence short-term outcomes. Design: Retrospective study. Setting: Pedriatic ICU in a university hospital Patients and Methods: The medical charts of all oncologic patients admitted to the PICU during the period from January 1983 to December 1992 were reviewed. Main Results: Over a period of 10 years, 51 oncologic patients were admitted on 57 occasions to the PICU. The mortality was 32%. This is significantly higher than the overall mortality in the PICU (8%). Comparison of observed and predicted mortality, derived from the PRISM score, using chi square goodness-of-fit tests showed a significantly higher observed mortality ( x(5)=20.1, P<0.01). Patients admitted for circulatory failure and the highest mortality (47%), followed by those with respiratory failure due to tachypnea/cyanosis (36%), central nervous system deterioration (27%), respiratory failure due to ariway obstruction (25%), and metabolic disorders (20%). Of the 31 patients who needed mechanical ventilation, 17 died (55%), and when they needed inotropic support as well, the mortality increased to 69%. The mortality rose to 100% when the patient was admitted with a septic shock, necessitating mechanical ventilation and inotropic support. The median PRISM score was 5 in the survivor group and 18.5 in the non-survivor group; this difference was found to be significant using the Wilcoxon test ( P=0.01). However, some patients with high scores were found in the survivor group, as well as some with low scores in the non-survivor group. Conclusion: The decision to treat opcologic patients in a PICU remains difficult and has to be considered on an individual basis. However, oncologic patients do benefit from admission to the PICU. The PRISM score is not suitable for oncologic patients in the PICU, because it underestimates the observed mortality. Other factors like neutropenia, septic shock, the need for mechanical ventilation, and inotropic support should be taken into consideration. [ABSTRACT FROM AUTHOR]

Objectives: To correlate lactate clearance with Pediatric Intensive Care Unit (PICU) mortality. Methods: 45 (mean age 40.15 mo, 60% males) consecutive admissions in the PICU were enrolled between May 2012 to June 2013. Lactate clearance (Lactate level at admission - level 6 hr later × 100 / lactate level at admission) in first 6 hours of hospitalization was correlated to in-hospital mortality and PRISM score. Results: Twelve out of 45 patients died. 90% died among those with delayed/poor clearance (clearance <30%) compared to 8.5% in those with good clearance (clearance >30%) (P<0.001). Lactate clearance <30% predicted mortality with sensitivity of 75%, specificity of 97%, positive predictive value of 90%, and negative predictive value of 91.42%. Predictability was comparable to PRISM score >30. Conclusion: Lactate clearance at six hours correlates with mortality in the PICU. [ABSTRACT FROM AUTHOR]

Background Diabetic ketoacidosis (DKA) is one of the most common complications of type 1 diabetes. Mortality is not uncommon in DKA, mostly in younger children with severe DKA and those complicated with cerebral edema. Early identification of high-risk patients can help in timely interventions to improve the outcome of DKA. Pediatric Risk of Mortality (PRISM III) is a standard scoring system to objectively predict the prognosis and outcome of pediatric intensive care unit (PICU) patients. Objective To predict the need for inotrope and mechanical ventilation and mortality rate using PRISM III in DKA patients admitted to PICU. Methods A prospective observational study was conducted in the PICU of the National Institute of Child Health, Karachi, from February 2020 to September 2021 involving 114 children. PRISM III scoring protocol was applied. A PRISM III score of >8 predicted higher mortality risk.  Results The mean PRISM III score was 6.56 ± 3.18 with 30 (26.3%) children having a score >8. Of the 30 (26.31%) patients with >8 PRISM III scores, 14 (46.67%) needed inotropic support, 6 (20%) needed mechanical ventilation, and there were eight (26.67%) mortalities. There was no reported mortality among patients with a PRISM III score ≤8. All differences were statistically significant (p < .05). Conclusion PRISM III is a highly sophisticated scoring system that can aid clinicians in the early prediction of adverse clinical outcomes in patients with DKA. Robust scientific evidence supporting its clinical application can help practically improve the outcome of DKA in young patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Baloch et al.)

Introduction The study aims to evaluate the association between a deficiency of Vitamin D level with the duration of hospital stay, pediatric intensive care unit (PICU) stay, and ventilation; the pediatric risk of mortality (PRISM) score, and the rate of readmission. Materials and methods This prospective observational study was conducted from November 2014 to October 2015, and the study population consisted of children admitted to the pediatric intensive care unit (PICU) in a tertiary care hospital of Puducherry. After measuring vitamin D levels, children were allotted into three categories depending on their serum 25(OH)D levels as the sufficient group (25[OH]D level ≥ 30 ng/mL), insufficient group (25[OH]D level = 20 - 29.9 ng/mL), and deficient group (25[OH]D level < 20 ng/mL). Among these three groups, the duration of hospital stay, PICU stay, and ventilation; the PRISM score, and the rate of readmission were compared. Results A total of 522 patients were included in the study. Based on their 25(OH)D level, 222 patients (42.5%) were in the sufficient category, 153 patients (29.3%) were in the deficient category, and 147 patients (28.2%) were in the insufficient category. Vitamin D deficiency state is not statistically significantly associated with the duration of hospital stay (P = .84), duration of PICU stay (P = .69), duration of ventilation (P = .48), PRISM score (P = .63), and rate of readmission (P = .91). Conclusions Longer hospital stay, prolonged PICU stay, longer duration of ventilation, and higher PRISM III score were independent risk factors for higher mortality in the PICU. However, lower vitamin D levels are not statistically significant to predict mortality among the study population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Das et al.)

We conducted this study to evaluate the outcome of 203 patients admitted to PICU, using PRISM score. Overall mortality was 16.7%. The mean PRISM score was 6.5±3.6 and 15.5±7 for survivors and non survivors, respectively (OR: 1.36; 95% CI=1.24--1.5; P<0.001). PRISM score also correlated well with length of hospital stay and the number of organ failures (P<0.001). A cut off score of 15 was associated with 89.2% accuracy. PRISM score is highly sensitive in predicting the outcome of pediatric patients in an ICU setting. [ABSTRACT FROM AUTHOR]