The Pediatric Risk of Mortality (PRISM) score and Injury Severity Score (ISS) for predicting resource utilization and outcome of intensive care in pediatric trauma

Objective: Mortality prediction in trauma is assessed using the Injury Severity Score (ISS) and Revised Trauma Score using Trauma Injury Severity Score (TRISS) methodology. The Pediatric Risk of Mortality (PRISM) score assesses mortality risk in critically ill children. We compared the ability of PRISM and ISS (using TRISS methodology) to predict resource utilization and outcome in pediatric trauma, Design: Retrospective chart and database review, Setting: Pediatric intensive care unit (PICU), Patients: Consecutive admissions to a PICU over a 2-yr period, Measurements and Main Results: Demographic data including PICU resource utilization and outcome were recorded. Data were recorded on 1,052 admissions (31 deaths), including 125 pediatric trauma patients (11 deaths). Patients were stratified into low- and high-risk categories based on PRISM and ISS scores. Patients with PRISM scores <6 and ISS scores <10 were classified as low risk, While both tow-risk PRISM and ISS scores readily identified survivors, PRISM was the more sensitive indicator of resource utilization, PRISM, however, performed less well in determining risk adjusted mortality as compared with ISS, Conclusion: PRISM readily stratifies pediatric trauma patients for resource utilization, PRISM appears to underestimate mortality in pediatric trauma as compared with ISS using TRISS methodology.