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. 2022 Dec 21;10(1):14.
doi: 10.3390/children10010014.

PRISM III Score Predicts Short-Term Outcome in Children with ARDS on Conventional and High-Frequency Oscillatory Ventilation

Snezana Rsovac  1   2 , Davor Plavec  3   4 , Dusan Todorovic  5 , Aleksa Lekovic  2 , Teja Scepanovic  6 , Marija Malinic  7 , Mina Cobeljic  1 , Katarina Milosevic  2   6
Affiliations

PRISM III Score Predicts Short-Term Outcome in Children with ARDS on Conventional and High-Frequency Oscillatory Ventilation

Snezana Rsovac et al. Children (Basel). .

Abstract

Therapeutic recommendations for pediatric acute respiratory distress syndrome (PARDS) include conventional (CMV) and rescue high-frequency oscillatory mode (HFOV) of mechanical ventilation (MV). The pediatric risk of mortality (PRISM) is a frequently used mortality score for critically ill patients. In search of methods to recognize those patients, we analyzed the PRISM III score as a potential predictor of the short-term outcome in MV subjects with PARDS. A retrospective five-year study of PARDS in children on MV was conducted in the Pediatric ICU. Seventy patients were divided into two groups (age group <1 year and age group 1−7 years). The PRISM III score was used to assess the 28-day outcome and possible development of complications. The most common causes of PARDS were pneumonia and sepsis. Male sex, malnourishment, sepsis, and shock were significant indicators of poor outcome. The PRISM III score values were significantly higher in those who died, as well as in subjects requiring HFOV. The score had a significant prognostic value for short-term mortality. There was no significant difference in outcome based on the comparison of two modes of ventilation. A significantly higher score was noted in subjects who developed sepsis and cardiovascular insufficiency. The PRISM III score is a fair outcome predictor during the 28-day follow-up in MV subjects with PARDS, regardless of the ventilation mode.

Keywords: ARDS; PRISM III score; mechanical ventilation; outcome; pediatric.

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Conflict of interest statement

There are no conflict of interest or industry funding relevant to this study to report for any of the authors. Davor Plavec reports grants, personal fees from GlaxoSmithKline; personal fees, non-financial support from Menarini, Philips, and Revenio; personal fees from Pliva, Boehringer Ingelheim, Belupo, Novartis, MSD, and Chiesi.

Figures

Figure 1
Figure 1
ROC analysis of PRISM III score for prediction on short-term mortality in PARDS. The blue line represents ROC curve for PRISM III score regarding the prediction of the short-term outcome. The green line is a diagonal reference line. Notes: Area under the ROC curve 0.755, SE 0.058, 95% CI 0.641–0.870, p < 0.001, Overall Sensitivity 64.1%, Overal Specificity 80.6%, Positive Predictive Value 0.860, Negative Predictive Value 0.641.
Figure 2
Figure 2
Kaplan–Meier survival curves for PRISM III score values which are < 13 and > 13 for prediction on short-term mortality in PARDS. Notes: Log Rank Mantel-Cox test: χ2 = 4.820; p= 0.028, Median: PRISM III < 13 = 28 days (Estimation is limited to the largest survival time if it is censored); PRISM III ≥ 13 = 11 days.
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