Grant Government Medical College and Sir

NAME OF PG COLLEGE
J.J Group of Hospitals,Mumbai.
Department Paediatrics
DR. Pallavi P. Saple
Name of the Guide and College
Grant Medical College and Sir J.J Group of
Name
Hospitals, Mumbai.400008
Contact No. of Guide 9757345222

Through proper channel

To,
The Registrar,
MUHS, Nashik, 422004
Sub:submission of Title of Synopsis of Dissertation

Respected Sir/Madam,
I, Dr. Sukena. Juzar. Susnerwala, registered for MD Paediatrics in June 2015
batch under the guidance of Dr.Pallavi P. Saple, Professor, Department of
Paediatrics, Grant Government Medical College ,Mumbai.
I am due to appear for MD PEADIATRICS in May 2018.
I am submitting the Title of Synopsis as mentioned below and as suggested
by my Guide.
Title Of Synopsis
COMPARISON OF MORTALITY PREDICTIVE SCORING SYSTEMS IN
PICU PATIENTS
Kindly accept and register my title of synopsis.

Dr. Sukena. Juzar. Susnerwala

Junior Resident
Department of Paediatrics

The qualification of the teacher is recognized by the Central Council.

Dr. Pallavi P. Saple Dr. Nita R. Sutay

[Guide name and Signature] [HOD Name and Signature with
dept seal]

Grant Government Medical College and Sir J.J Group of Hospitals

[Signature and Seal of Dean of College]
 Dr Sukena. Juzar. Susnerwala
Junior resident,
Department of Pediatrics
Grant Government medical college
Mumbai- 400008
Date:

To,
The Chairman /Secretary,
Institutional Ethics Committee[Human Research]
Grant Government Medical College and Sir J.J Hospital,
Byculla, Mumbai -400008

Sub:Submission of Dissertation topic for Institutional Ethics Committee review

Course:MD Subject :Paediatrics

Respected Sir,

I,Dr.Sukena. Juzar. Susnerwala , am registered for MD Paediatrics 2015

under the guidance of:
Name of the Guide: Dr. Pallavi P. Saple
Designation: Professor
Department: Paediatrics, Grant Government Medical College and Sir J.J
Hospital.
I am due to appear for MD Paediatrics exam in May 2018
I am submitting following documents of the project titled “COMPARISON OF
MORTALITY PREDICTIVE SCORING SYSTEMS IN PICU PATIENTS “ for
review to Institutional Ethics Committee and Human Research. This study will
be conducted at Grant Medical College and Sir J.J Hospital, Mumbai.
Submitting herewith
1. Dissertation Application
2. Synopsis of dissertation
3. Proforma
4. Informed Consent Form

Dr.Sukena. Juzar. Susnerwala

P.G Student

Dr. Pallavi P. Saple Dr. Nita R. Sutay

[Guide name and Signature] [HOD Name & Signature with dept seal]
Department Paediatrics
Candidate’s Academic Year 2015
Course and Subject
MD PAEDIATRICS
College Name and Address Grant Govt. Medical College Mumbai

Dr Dr. Pallavi P. Saple Dr. Nita R. Sutay

[Guide name and Signature] [HOD Name & Signature with dept seal]

Dr.Sukena. Juzar. Susnerwala

P.G Student
Department of Paediatrics
Grant Government Government Medical College,
Mumbai- 400008

Subject:- Regarding Your research proposal of dissertation topic titled

“ COMPARISON OF MORTALITY PREDICTIVE SCORING SYSTEMS IN
PICU PATIENTS”

Dear Student,
The above mentioned research proposal of dissertation topic was discussed
in the ethical committee meeting held on ________________ at our college.
Ethical committee has unanimously approved your dissertation topic. This
work will be done under the guidance and supervision of your guide Dr.
Pallavi P. Saple.

(Signature)
Chairperson , Ethical Committee
Grant Government Medical college Mumbai
 GENERAL INFORMATION
Title of Dissertation : COMPARISON OF MORTALITY PREDICTIVE
SCORING SYSTEMS IN PICU PATIENTS
1. Name and Designation
a. Post Graduate student: Dr .Sukena. Juzar. Susnerwala
P.G Student
Dept. of Pediatrics
Grant Medical College,
Mumbai
b. Post Graduate Guide: Dr. Pallavi P. Saple
Professor
Dept. of Paediatrics
Grant Medical College,
Mumbai.
2.Duration of Research activity: 24months, ACADEMIC YEAR MAY 2015-
MAY2018
a. Period required for data collection: 18months
b. Period required for analyzing data: 3 months
c. Deadline for submission of dissertation to the university: Dec 2017,

3.Signature

Dr Dr. Pallavi P. Saple Dr. Nita R. Sutay

[Guide name and Signature] [HOD Name & Signature with dept seal]

Dr.Sukena. Juzar. Susnerwala

P.G Student
Department of Paediatrics
Grant Government Medical College,
Mumbai- 400008

4.Date of submission to the ethical committee

5.Date of clearance by ethical committee
7.Remarks by chairman of Ethical committee
 INTRODUCTION

Predictive scoring systems have been developed to measure the severity of

disease and prognosis of patients in the intensive care unit [ICU]. Such
scoring systems are useful in clinical decision making, standardizing research
and comparing the quality of patient care across ICUs. Different scoring
systems have been developed, each considering different parameters that
can be used in the same setting. I have chosen this topic, and have
specifically chosen the APACHE II, SOFA, MODS [which can be used in both,
adults and children under intensive care] and PRISM [which is specific for
pediatric patients under intensive care] for comparison as they are rampantly
used across the globe and are efficient individually. A comparison of these
scoring systems in predicting the mortality in PICU patients would help us
choose one system which proves to be superior to the others in predicting the
same and alter the course with timely changes if necessary in the
management.

1.APACHEII [ACUTE PHYSIOLOGICAL AND CHRONIC HEALTH

EVALUATION] SCORE:

The APACHE II is the most widely used ICU mortality prediction score. This score
can be calculated on all patients newly admitted to the intensive care unit. While
it is not mandatory and hurts with patient management, it is a useful tool for risk
stratification and to compare the care received by patients with similar
characteristics in different ICU settings. 12 variables are considered while
predicting the mortality

1. Pa02 or Fio2 2. Temperature [rectal]

3. mean arterial pressure 4. pH [arterial]
5. heart rate 6. respiratory rate
7. sodium levels 8. potassium levels
9. creatinine 10.hematocrit
11. white blood cell count 12. glasgow coma scale.

2. SOFA [SEQUENTIAL ORGAN FAILURE ASSESSMENT]:

The SOFA score is a mortality prediction score based on dysfunction of 6

organ systems. The scores can be used in several ways:
 As individual scores for each organ to determine progression of organ
dysfunction.
 As the scores on one ICU day.As worst scores during ICU stay.
The variables considered are:
1. Respiratory system – pa02/fi02
2.nervous system [Glasgow coma scale]
3. cardiovascular system [mean arterial pressure]
4.liver function [bilirubin]
5.coagulation profile[platelet count]
6.renal system [creatinine] .

3.MODS [MULTIPLE ORGAN DYSFUNCTION SCORE]

The MODS (Multiple Organ Dysfunction Score) Score was developed in 1995
as a physiology based tool to describe organ dysfunction as an ICU outcome.
A formal methodological approach was used to employ physiologic, rather
than therapeutic variables. The authors wanted to minimize bias resulting
from differing approaches to therapy, but also to emphasize the role of the
scoring system as a descriptor of a pathophysiologic process, rather than of
the clinician’s response to that process.

4. PRISM SCORE [PEDIATRIC RISK OF MORTALITY SCORE]:

The Pediatric Risk of Mortality (PRISM) score is one of the main indicators
used in the pediatric intensive care unit. It was obtained and validated from
the Physiologic Stability Index (PSI) with 1415 patients evaluated in PICU
between 1984 and 1985, and the mortality rate was of 116. Statistical analysis
eliminated the insignificant PSI categories reducing the number of
physiological parameters, creating and validating the PRISM. It uses 14
parameters (physiological and laboratory data) and for each was used the
highest severity value recorded in the first 24 hours. The risk of death is
calculated by a logistic regression equation using the value of the PRISM,
patient age and need of surgery on admission to the PICU,but performance
was not influenced by the post operative status of the patients. It presents an
excellent discriminatory performance and prediction, being used in many
PICUs as a prognostic score to assess gravity of disease. The variables
considered were:
(1) Systolic blood pressure and age
(2) Diastolic blood pressure
(3) Heart rate
(4) Respiratory rate
(5) PaO2 to FIO2 ratio
(6) PaCO2
(7) Glasgow coma score
(8) Pupillary reflex to light
(9) PT and PTT
(10) Total serum bilirubin
(11) Serum potassium
(12) Serum total calcium
(13) Glucose
(14) Bicarbonate .
 AIMS AND OBJECTIVES

 To compare the mortality predictive scoring sytems- 'APACHE 2', '

SOFA' 'MODS' and 'PRISM' in patients admitted in pediatric intensive
care units in a tertiary care centre.
 To compare the efficacy of these scoring systems along different
parameters, including length of stay in the pediatric ICU and the
probability of ventilator requirement.

MATERIALS AND METHODS

Inclusion criteria
All children between 1month-12 years of age [male and female] admitted in
picu to be considered.

Exclusion criteria
Neonates and patients admitted the in ward are not to be considered.

STUDY DESIGN
It is a comparative clinical study where patients between 1mnth-12 years of
age admitted in the pediatric intensive care unit will be considered.4 Mortality
predictive scoring systems namely APACHEII, SOFA, MODS and PRISM will
be calculated for each patient. The efficiency of the scoring systems in
comparing mortality will be compared.

THE SCORING SYSTEMS, THEIR VARIABLES AND CALCULATION

METHODS HAVE BEEN ENLISTED BELOW:

APACHE II

1. Pa02 or Fio2
2. Temperature [rectal]
3. mean arterial pressure
4. pH [arterial]
5. heart rate
6. respiratory rate
7. sodium levels
8. potassium levels
9. creatinine
10.hematocrit
11. white blood cell count
12. glasgow coma scale.

INTERPRETATION:
The APACHE II Severity of Disease Classification System
High
Abno
rmal
Rang
e
Physio
logic
Variabl
e
Low
Abno
rmal
Rang
e

Point
+4 +3 +2 +1 0 +1 +2 +3 +4
s

Temper
38.5
ature - 39 to 36 to 34 to 32 to 30 to <29.9
>41° to
rectal 40.9° 38.4° 35.9° 33.9° 31.9° °
38.9°
(°C)

Mean
Arterial
130 to 110 to 70 to 50 to
Pressu >160 <49
159 129 109 69
re -
mm Hg

Heart
Rate
(ventric 140 to 110 to 70 to 55 to 40 to
>180 <39
ular 179 139 109 69 54
respon
se)

Respir
atory
Rate 35 to 25 to 12 to 10 to
(non- >50 6 to 9 <5
49 34 24 11
ventilat
ed or
ventilat
ed)
Oxyge
nation:
A-
aDO2 <200
or
PaO2 350 to 200 to
>500
(mm 499 349
Hg)
a. FIO2 PO2> PO2 PO2
PO2<
>0.5 70 61 to 55 to
55
record 70 60
A-
aDO2
b. FIO2
<0.5
record
PaO2
Arterial
pH
(preferr
ed)

Serum 7.33 7.25 7.15

HCO3 >7.7 7.6 to 7.5 to <7.15
to to to
(venou 7.69 7.59
7.49 7.32 7.24
s
mEq/l) 41 to 32 to
>52 22 to 18 to 15 to <15
(not 51.9 40.9
31.9 21.9 17.9
preferr
ed, but
may
use if
no
ABGs)
Serum
Sodiu 160 to 155 to 150 to 130 to 120 to 111 to
>180 <110
m 179 159 154 149 129 119
(mEq/l)

Serum
Potassi 6 to 5.5 to 3.5 to 3 to 2.5 to
>7 <2.5
um 6.9 5.9 5.4 3.4 2.9
(mEq/l)

Serum
Creatin
ine
(mg/dl)
Double 2 to 1.5 to 0.6 to
>3.5 <0.6
point 3.4 1.9 1.4
score
for
acute
renal
failure
Hemat
50 to 46 to 30 to 20 to
ocrit >60 <20
59.9 49.9 45.9 29.9
(%)

White
Blood
Count 20 to 15 to 3 to 1 to
>40 <1
(total/m 39.9 19.9 14.9 2.9
m3)
(in
1000s)
Glasgo
w
Coma
Score
(GCS)
Score
= 15
minus
actual
GCS
A. Total
Acute
Physiol
ogy
Score
(sum of
12
above
points)

B. Age
points
(years)
<44=0;
45 to
54=2;
55 to
64=3;
65 to
74=5;
>75=6

C.
Chroni
c
Health
Points
(see
below)

Total
APACH
E II
Score
(add
togethe
r the
points
from
A+B+C
)

Chronic Health Points: If the patient has a history of severe organ system insufficiency or is
immunocompromised assign points:
5 points for nonoperative or emergency postoperative patients
2 points for elective postoperative patients
Definitions: organ insufficiency or immunocompromised state must have been evident prior to this hospital admission and conform
to these criteria:

Liver – biopsy proven cirrhosis and documented portal hypertension; episodes of past upper GI bleeding attributed to portal
hypertension; or prior episodes of hepatic failure/encephalopathy/coma.
Cardiovascular – New York Heart Association Class IV.
Respiratory – Chronic restrictive, obstructive, or vascular disease resulting in severe exercise restriction (i.e., unable to climb
stairs or perform household duties; or documented chronic hypoxia, hypercapnia, secondary polycythemia, severe
pulmonary hypertension (>40 mmHg), or respirator dependency.
Renal – receiving chronic dialysis.
 Immunocompromised – the patient has received therapy that suppresses resistance to infection (e.g., immunosuppression,
chemotherapy, radiation, long term or recent high dose steroids, or has a disease sufficiently advanced to suppress
resistance to infection, e.g., leukemia, lymphoma, AIDS).
Interpretation of Score:

Score Death Rate (%)

0-4 4

5-9 8

10-14 15

15-19 25

20-24 40

25-29 55

30-34 75

>34 85

SOFA
1.Respiratory system [pao2/fio2]
PaO2/FiO2 (mmHg) SOFA score
<400 1
<300 2
<200 and mechanically ventilated 3
<100 and mechanically ventilated 4

2. Nervous System
Glasgow coma scale SOFA score
13–14 1
10–12 2
6–9 3
<6 4

3. Cardio Vascular System

Mean Arterial Pressure OR
administration of vasopressors SOFA score
required
MAP <70mm/Hg 1
dop <=5 or dob (any dose) 2
dop >5 OR epi <=0.1 OR nor <=0.1 3
dop >15 OR epi >0.1 OR nor >0.1 4
(vasopressor drug doses are in µg/kg/min)
Drug abbreviations: dop for dopamine, dob for dobutamine, epi for
epinephrine and nor for norepinephrine.

4. Liver
Bilirubin (mg/dl) [μmol/L] SOFA score
1.2–1.9 [>20-32] 1
2.0–5.9 [33-101] 2
6.0–11.9 [102-204] 3
> 12.0 [>204] 4
5. Coagulation
Platelets×103/µl SOFA score
<150 1
<100 2
<50 3
<20 4

6. Renal System
Creatinine (mg/dl) [μmol/L] (or urine
SOFA score
output)
1.2–1.9 [110-170] 1
2.0–3.4 [171-299] 2
3.5–4.9 [300-440] (or <500ml/d) 3
> 5.0 [>440] (or <200ml/d) 4

Maximum
SOFA Score Mortality

0 to 6 < 10%
7 to 9 15 - 20%
10 to 12 40 - 50%
13 to 14 50 - 60%
15 > 80%
15 to 24 > 90%

MODS

1. Respiratory system-pao2/fio2
2. Creatinine -
3. Bilirubin levels-
4. Pressure adjusted heart rate-
5. Platelet count:
6. Glasgow coma scale:

0 points: ICU Mort 0%,

1-4 points: ICU Mort 1-2%,
5-8 points: ICU Mort 3-5%,
9-12 points: ICU Mort 25%,
13-16 points: ICU Mort 50%,
17-20 points: ICU Mort 75%,
21-24 points: ICU Mort 100%,

PRISM SCORE:

(1) Systolic blood pressure

(2) Diastolic blood pressure
(3) Heart rate
(4) Respiratory rate
(5) PaO2 to FIO2 ratio
(6) PaCO2
(7) Glasgow coma score
(8) Pupillary reflex to light
(9) PT and PTT
(10) Total serum bilirubin
(11) Serum potassium
(12) Serum total calcium
(13)Glucose
(14)Bicarbonate

Total score:

Parameter
Pediatric Risk Of Mortality (PRISM)

1.Systolic blood pressure [in mm Hg ]

infants 130-160 2
55-65 2
> 160 6
40-54 6
< 40 7
children
150-200 2
65-75 2
> 200 6
50-64 6
< 50 7

2.Diastolic blood [pressure in mm hg]

all ages > 110 mm Hg

3.heart rate in bpm: infants: >160 4

<90 4
children >150 4
<80 4

4. respiratory rate: infants 61-90 1

> 90 5
apnea 5
children 51-70 1
>70 5
apnea 5

5. pao2/fio2 all ages 200-300 2

<200 3

6. paco2 all ages 51-65 1

>65 5

7.glassgow coma scale <8 6

8.pupillary reflex: unequal or dilated 4

fixed and dilated 10

9.PT/PTT all ages 1.5 times control 2

10.total bilirubin >1mnth >3.5 6

11.potassium in [meq] all ages 3-3.5 1

6.5-7.5 1
<3 5
>7.5 5

12.calcium in mg/dl all ages 7-8 2

12-15 2
<7 6
>15 6

13.glucose in mg/dl all ages 40-60 4

250-400 4
<40 6
>400 6
 PROFORMA
Name :

Mrd No:

Date and time of admission:

Date of death/discharge:

Age: years months

Gender: male female

Weight:

Height:

Chief complaints:

History:

Birth history : normal/csection

birth wght:
nicu admission : yes/no

Development history : normal/abnormal

DQ:

Immunization history: completely/partially/unimmunized

Nutritional history: appropriate for age
0 to -3 sd
< -3sd
> -3sd

On oxygen: hood/ nasal prongs/ mask

litres:

CPAP [by bubble]: Yes/no

If yes , PEEP : [DAYS] [on day of discharge/death]

Ventilated : Yes / No
If yes : mode: SIMV
CPAP

If CPAP , then PEEP: [days] [on day of

death/discharge]

days day of discharge

/death
If SIMV , PEEP:
FIO2:
PIP :
RR:
I/E:

Inotropes : [days] [day of discharge/death]

If yes : Dobutamine
Dopamine
Noradrenaline
Adrenaline
 other [specify]

Other drugs : Antibiotics [specify]

Antiepileptics :

Antimalarials :

Antifungals:

Electrolyte correction:

Antifailure:

Bronchodilators:

anticholinergic

anticoagulants:

akt:
steroids:

Procedures done:

Provsional diagnosis:

Final diagnosis:
INTERPRETATION:
The APACHE II Severity of Disease Classification System
High
Abno
rmal
Rang
e
Physio
logic
Variabl
e
Low
Abno
rmal
Rang
e

Point
+4 +3 +2 +1 0 +1 +2 +3 +4
s

Temper
38.5
ature - 39 to 36 to 34 to 32 to 30 to <29.9
>41° to
rectal 40.9° 38.4° 35.9° 33.9° 31.9° °
38.9°
(°C)

Mean
Arterial
130 to 110 to 70 to 50 to
Pressu >160 <49
159 129 109 69
re -
mm Hg

Heart
Rate
(ventric 140 to 110 to 70 to 55 to 40 to
>180 <39
ular 179 139 109 69 54
respon
se)

Respir
atory
Rate 35 to 25 to 12 to 10 to
(non- >50 6 to 9 <5
49 34 24 11
ventilat
ed or
ventilat
ed)
Oxyge
nation:
A- <200
aDO2
or 350 to 200 to
>500
PaO2 499 349
(mm
Hg) PO2> PO2 PO2
PO2<
a. FIO2 70 61 to 55 to
55
>0.5 70 60
record
A-
aDO2
b. FIO2
<0.5
record
PaO2
Arterial
pH
(preferr
ed)

Serum 7.33 7.25 7.15

HCO3 >7.7 7.6 to 7.5 to <7.15
to to to
(venou 7.69 7.59
7.49 7.32 7.24
s
mEq/l) 41 to 32 to
>52 22 to 18 to 15 to <15
(not 51.9 40.9
31.9 21.9 17.9
preferr
ed, but
may
use if
no
ABGs)
Serum
Sodiu 160 to 155 to 150 to 130 to 120 to 111 to
>180 <110
m 179 159 154 149 129 119
(mEq/l)

Serum
Potassi 6 to 5.5 to 3.5 to 3 to 2.5 to
>7 <2.5
um 6.9 5.9 5.4 3.4 2.9
(mEq/l)

Serum
Creatin
ine
(mg/dl)
Double 2 to 1.5 to 0.6 to
>3.5 <0.6
point 3.4 1.9 1.4
score
for
acute
renal
failure
Hemat
50 to 46 to 30 to 20 to
ocrit >60 <20
59.9 49.9 45.9 29.9
(%)

White
Blood
Count 20 to 15 to 3 to 1 to
>40 <1
(total/m 39.9 19.9 14.9 2.9
m3)
(in
1000s)
Glasgo
w
Coma
Score
(GCS)
Score
= 15
minus
actual
GCS
A. Total
Acute
Physiol
ogy
Score
(sum of
12
above
points)

B. Age
points
(years)
<44=0;
45 to
54=2;
55 to
64=3;
65 to
74=5;
>75=6

C.
Chroni
c
Health
Points
(see
below)

Total
APACH
E II
Score
(add
togethe
r the
points
from
A+B+C
)

Chronic Health Points: If the patient has a history of severe organ system insufficiency or is
immunocompromised assign points:
5 points for nonoperative or emergency postoperative patients
2 points for elective postoperative patients
Definitions: organ insufficiency or immunocompromised state must have been evident prior to this hospital admission and conform
to these criteria:
Liver – biopsy proven cirrhosis and documented portal hypertension; episodes of past upper GI bleeding attributed to portal
hypertension; or prior episodes of hepatic failure/encephalopathy/coma.
Cardiovascular – New York Heart Association Class IV.
Respiratory – Chronic restrictive, obstructive, or vascular disease resulting in severe exercise restriction (i.e., unable to climb
stairs or perform household duties; or documented chronic hypoxia, hypercapnia, secondary polycythemia, severe
pulmonary hypertension (>40 mmHg), or respirator dependency.
 Renal – receiving chronic dialysis.
Immunocompromised – the patient has received therapy that suppresses resistance to infection (e.g., immunosuppression,
chemotherapy, radiation, long term or recent high dose steroids, or has a disease sufficiently advanced to suppress
resistance to infection, e.g., leukemia, lymphoma, AIDS).
Interpretation of Score:

Score Death Rate (%)

0-4 4

5-9 8

10-14 15

15-19 25

20-24 40

25-29 55

30-34 75

>34 85
SOFA

1.Respiratory system [pao2/fio2]

PaO2/FiO2 (mmHg) SOFA score
<400 1
<300 2
<200 and mechanically ventilated 3
<100 and mechanically ventilated 4

2. Nervous System
Glasgow coma scale SOFA score
13–14 1
10–12 2
6–9 3
<6 4

3. Cardio Vascular System

Mean Arterial Pressure OR
administration of vasopressors SOFA score
required
MAP <70mm/Hg 1
dop <=5 or dob (any dose) 2
dop >5 OR epi <=0.1 OR nor <=0.1 3
dop >15 OR epi >0.1 OR nor >0.1 4
(vasopressor drug doses are in µg/kg/min)
Drug abbreviations: dop for dopamine, dob for dobutamine, epi for
epinephrine and nor for norepinephrine.

4. Liver
Bilirubin (mg/dl) [μmol/L] SOFA score
1.2–1.9 [>20-32] 1
2.0–5.9 [33-101] 2
6.0–11.9 [102-204] 3
> 12.0 [>204] 4
5. Coagulation
Platelets×103/µl SOFA score
<150 1
<100 2
<50 3
<20 4

6. Renal System
Creatinine (mg/dl) [μmol/L] (or urine
SOFA score
output)
1.2–1.9 [110-170] 1
2.0–3.4 [171-299] 2
3.5–4.9 [300-440] (or <500ml/d) 3
> 5.0 [>440] (or <200ml/d) 4

Maximum
SOFA Score Mortality

0 to 6 < 10%
7 to 9 15 - 20%
10 to 12 40 - 50%
13 to 14 50 - 60%
15 > 80%
15 to 24 > 90%

MODS

7. Respiratory system-pao2/fio2
8. Creatinine -
9. Bilirubin levels-
10. Pressure adjusted heart rate-
11. Platelet count:
12. Glasgow coma scale:

0 points: ICU Mort 0%,

1-4 points: ICU Mort 1-2%,
5-8 points: ICU Mort 3-5%,
9-12 points: ICU Mort 25%,
13-16 points: ICU Mort 50%,
17-20 points: ICU Mort 75%,
21-24 points: ICU Mort 100%,

PRISM SCORE:

(1) Systolic blood pressure

(2) Diastolic blood pressure
(3) Heart rate
(4) Respiratory rate
(5) PaO2 to FIO2 ratio
(6) PaCO2
(7) Glasgow coma score
(8) Pupillary reflex to light
(9) PT and PTT
(10) Total serum bilirubin
(11) Serum potassium
(12) Serum total calcium
(13)Glucose
(14)Bicarbonate

Total score:

Parameter
Pediatric Risk Of Mortality (PRISM)

1.Systolic blood pressure [in mm Hg ]

infants 130-160 2
55-65 2
> 160 6
40-54 6
< 40 7
children
150-200 2
65-75 2
> 200 6
50-64 6
< 50 7

2.Diastolic blood [pressure in mm hg]

all ages > 110 mm Hg

3.heart rate in bpm: infants: >160 4

<90 4
children >150 4
<80 4

4. respiratory rate: infants 61-90 1

> 90 5
apnea 5
children 51-70 1
>70 5
apnea 5

5. pao2/fio2 all ages 200-300 2

<200 3

6. paco2 all ages 51-65 1

>65 5

7.glassgow coma scale <8 6

8.pupillary reflex: unequal or dilated 4

fixed and dilated 10

9.PT/PTT all ages 1.5 times control 2

10.total bilirubin >1mnth >3.5 6

11.potassium in [meq] all ages 3-3.5 1

6.5-7.5 1
<3 5
>7.5 5

12.calcium in mg/dl all ages 7-8 2

12-15 2
<7 6
>15 6

13.glucose in mg/dl all ages 40-60 4

250-400 4
<40 6
>400 6
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