Bedside clinical prediction tool for mortality in critically ill children

TL;DR

A new clinical tool predicts mortality in critically ill children using factors like blood parameters and drug use.

Contribution

A novel prediction score for PICU mortality in children based on clinical parameters and hemogram data.

Findings

The score uses four predictors: male gender, vasoactive drugs, RDW ≥15.9%, and PDW categories.

The tool achieved an AuROC of 0.86 with 82.8% sensitivity and 73.1% specificity.

A cutoff score of 5 differentiates low-risk and high-risk groups for mortality.

Abstract

Mortality rates among critically ill pediatric patients remain a persistent challenge. It is imperative to identify patients at higher risk to effectively allocate appropriate resources. Our study aimed to develop a prediction score based on clinical parameters and hemogram to predict pediatric intensive care unit (PICU) mortality.

We conducted a retrospective study to develop a clinical prediction score using data from children aged 1 month to 18 years admitted for at least 24 hours to the PICU at Chiang Mai University between January 2018 and December 2022. PICU mortality was defined as death within 28 days of admission. The score was developed using multivariable logistic regression and assessed for calibration and discrimination.

There were 29 deaths in 330 children (8.8%). Our model for predicting 28-day ICU mortality uses four key predictors: male gender, use of vasoactive drugs, red blood cell distribution width (RDW) ≥15.9%, and platelet distribution width (PDW), categorized as follows: <10% (0 points), 10–14.9% (2 points), and ≥15% (4 points). Scores range from 0 to 8, with a cutoff value of 5 to differentiate low-risk (<5) from high-risk (≥5) groups. The tool demonstrates excellent performance with an AuROC curve of 0.86 (95% CI: 0.80–0.91, p<0.001) showing excellent discrimination and calibration, 82.8% sensitivity, and 73.1% specificity, respectively.

The score, developed from clinical data and hemogram, demonstrated potential in predicting ICU mortality among critically ill children. However, further studies are necessary to externally validate the score before it can be confidentially implemented in clinical practices.

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