Abstract:

Objective To analyze the applicability of three scoring systems of severity of illness for the evaluation of children with complex congenital heart diseases (CHD) after operations. Methods The general data of 237 patients were collected and the results of operations were scored according to the requirements of three scoring systems, i.e. the pediatric risk of mortality score (PRISM), pediatric risk of mortality score Ⅲ (PRISM Ⅲ), and pediatric clinical illness score (PCIS). The intra-class correlation coefficient (ICC) was used to measure the inter-rater reliability. The performance and applicability of the three scoring systems were evaluated by the Ttest, area under the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow goodness of fit test, and missing value analysis. Results Among 237 children with complex CHD, 24 died after operations and 213 survived. ICC＞0.8 meant that the collected data was reliable. Scores of PRISM and PRISM III of the death group (22.3±6.9 and 15.7±7.1) were significantly higher than those of the survival group (19.3±6.5 and 11.1±4.7) and the differences were statistically significant (P<0.05). But the difference of scores of PCIS between the death group (79.6±5.5) and survival group (81.9±7.6) was not statistically significant (P>0.05). The calibration capability of the three scores was good (P>0.05), but the discriminatory ability was insufficient. The AUCs of PRISM, PRISM III, and PCIS were 0.695, 0.724, and 0.220, respectively. Some indexes of three scoring systems were missed due to incompatibility with the work pattern of care units of our country. Conclusion The clinical applicability of PRISM, PRISM III, and PCIS for the evaluation of children with complex CHD after operations was not ideal and need to be improved. It is necessary to optimize evaluation indexes that are more sensitive to these diseases to build more specific scoring systems based on existing scoring systems.

Key words: Pediatric Risk of Mortality Score, Pediatric Risk of Mortality Score Ⅲ, Pediatric Clinical Illness Score, congenital heart disease