Evaluation of the pSOFA Score in a Pediatric Intensive Care Unit and Its Discriminative Performance Compared with PRISM 4 and PIM 3

Abstract

Objectives: We aimed to evaluate the performance of the age-adapted Pediatric Sequential Organ Failure Assessment (pSOFA) score, as a predictor of mortality in patients admitted to pediatric intensive care units (PICUs), and to compare it with the Pediatric Risk of Mortality 4 (PRISM 4) and Pediatric Index of Mortality 3 (PIM 3) scores. Methods: This single-center, retrospective study analyzed data from 1440 eligible PICU admissions to a tertiary PICU. The pSOFA, PRISM 4, and PIM 3 scores were calculated retrospectively for each patient. Results: The overall mortality was 13.1%, and the median length of stay was 11 days. The median (IQR) pSOFA score was significantly higher in non-survivors than in survivors [6 (4-10) vs. 3 (2-4), p < 0.001]. Mortality increased significantly with increasing pSOFA scores (p < 0.001). The area under the receiver operating characteristic curve (AUC) values for pSOFA, PRISM 4, and PIM 3 were 0.807, 0.847, and 0.781, respectively. The pSOFA score exhibited a significant positive correlation with both PRISM 4 and PIM 3 (p < 0.001). PRISM 4 and PIM 3 demonstrated evidence of miscalibration in this cohort, with observed mortality exceeding mean predicted mortality for both models. Conclusions: pSOFA demonstrated good discrimination for PICU mortality and a strong association with mortality in this single-center retrospective cohort. PRISM 4 showed significantly greater discrimination than pSOFA, whereas pSOFA and PIM 3 did not differ significantly. These findings support further prospective multicenter evaluation before broader clinical implementation.