Performance of PIM, PRISM, and PELOD scores in a resource-limited North Indian paediatric intensive care unit
Abstract
BACKGROUND: Pediatric mortality prediction models are widely used in high-income nations but remain under-validated in resource-limited settings with different disease profiles and care resources. This study evaluated the performance of pediatric risk of mortality score III (PRISM-III), pediatric index of mortality-3 (PIM-3), and pediatric logistic organ dysfunction score-2 (PELOD-2) in predicting mortality in a resource limited paediatric intensive care unit.
AIM: To determine the discriminative ability and calibration of PRISM III, PIM-3, and PELOD-2 for predicting 30-day mortality.
METHODS: This was an observational study over 15 months and included 175 children aged 1 month to 18 years. Physiological variables were recorded within the first hour (PIM-3) and the first 24 hours (PRISM III, PELOD-2). Performance was measured using the area under the receiver operating characteristic curve for discrimination and the Hosmer-Lemeshow goodness-of-fit test for calibration.
RESULTS: The observed mortality rate in the cohort was 13.7% (24 deaths). Mortality was significantly associated with sepsis and the early requirement for mechanical ventilation or inotropes. All scores showed high negative predictive values (> 95%) and excellent calibration (Hosmer-Lemeshow P values: PRISM-III = 0.952, PIM-3 = 0.692, PELOD-2 = 0.518), with standardized mortality ratio of 1.04, indicating accurate overall mortality prediction. PIM-3 achieved the highest discrimination (area under the receiver operating characteristic 0.951), followed closely by PELOD-2 (0.939), while PRISM III performed lowest (0.884). PELOD-2 offered the highest sensitivity (87.5%).
CONCLUSION: All three scores fit the observed risk distribution well, demonstrating clinically acceptable discrimination and calibration for predicting mortality in the local patient population. However, the small number of mortality events limits the precision of these estimates and precludes claims of broader applicability.
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BibTeX
@article{sood2026performance,
title = {{Performance of PIM, PRISM, and PELOD scores in a resource-limited North Indian paediatric intensive care unit}},
author = {Mangla Sood and Shreya Modi and Ishaan Sood},
journal = {World Journal of Clinical Pediatrics},
year = {2026},
month = nov,
doi = {10.5409/wjcp.120054},
url = {https://doi.org/10.5409/wjcp.120054},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Performance of PIM, PRISM, and PELOD scores in a resource-limited North Indian paediatric intensive care unit
AU - Mangla Sood
AU - Shreya Modi
AU - Ishaan Sood
PY - 2026
DA - 2026/11/03
JO - World Journal of Clinical Pediatrics
DO - 10.5409/wjcp.120054
UR - https://doi.org/10.5409/wjcp.120054
AB - BACKGROUND: Pediatric mortality prediction models are widely used in high-income nations but remain under-validated in resource-limited settings with different disease profiles and care resources. This study evaluated the performance of pediatric risk of mortality score III (PRISM-III), pediatric index of mortality-3 (PIM-3), and pediatric logistic organ dysfunction score-2 (PELOD-2) in predicting mortality in a resource limited paediatric intensive care unit. AIM: To determine the discriminative ability and calibration of PRISM III, PIM-3, and PELOD-2 for predicting 30-day mortality. METHODS: This was an observational study over 15 months and included 175 children aged 1 month to 18 years. Physiological variables were recorded within the first hour (PIM-3) and the first 24 hours (PRISM III, PELOD-2). Performance was measured using the area under the receiver operating characteristic curve for discrimination and the Hosmer-Lemeshow goodness-of-fit test for calibration. RESULTS: The observed mortality rate in the cohort was 13.7% (24 deaths). Mortality was significantly associated with sepsis and the early requirement for mechanical ventilation or inotropes. All scores showed high negative predictive values (> 95%) and excellent calibration (Hosmer-Lemeshow P values: PRISM-III = 0.952, PIM-3 = 0.692, PELOD-2 = 0.518), with standardized mortality ratio of 1.04, indicating accurate overall mortality prediction. PIM-3 achieved the highest discrimination (area under the receiver operating characteristic 0.951), followed closely by PELOD-2 (0.939), while PRISM III performed lowest (0.884). PELOD-2 offered the highest sensitivity (87.5%). CONCLUSION: All three scores fit the observed risk distribution well, demonstrating clinically acceptable discrimination and calibration for predicting mortality in the local patient population. However, the small number of mortality events limits the precision of these estimates and precludes claims of broader applicability.
SN - 2219-2808
ER -