Can generic scores (Pediatric Risk of Mortality and Pediatric Index of Mortality) replace specific scores in predicting the outcome of presumed meningococcal septic shock in children?

Objective: To compare, in children with septic shock and purpura, the accur acy in predicting death of two specific scores (the MenOPP bedside clinical [MOC] score of Gedde Dahl and the score of Groupe Francophone de Reanimati on Pediatrique [GFRP]), the G-reactive protein (CRP) level, and the two ped iatric generic scores (the Pediatric Risk of Mortality [PRISM] and Pediatri c Index of Mortality [PIM] scores). Design: Prospective, population-based study with analysis of previous compa rative studies. Setting: A 14-bed pediatric intensive care unit in a university hospital. Patients: All children admitted consecutively to the pediatric intensive ca re unit with septic shock and purpura (n = 58, with 16 deaths [27.6%]) from January 1993 to May 2000. Interventions: None. Measurements and Main Results: The MOC and GFRP scores and the GRP level we re prospectively determined at admission. The PRISM score was prospectively calculated within 24 hrs of admission or at the time of death, and the PIM score was calculated retrospectively between 1993 and 1997 and then prospe ctively from admission data. The nonparametric estimate of the area under t he receiver operating characteristic curves (AUC) was calculated from the r aw data using the Wilcoxon-Mann-Whitney two-sample statistic, and the stand ard error of the AUCs was calculated with DeLong's method. All the scores h ad an AUC >0.80, the PRISM probability of death having the best one (0.96 /- 0.02). The PRISM value, which is easier to calculate, had an AUC of 0.95 +/- 0.02. The PRISM score performed significantly better than the PIM scor e (AUG, 0.83 +/- 0.06; p < .01) and the CRP level (AUC, 0.80 +/- 0.06; p <. 01); however, there was no significant difference between the MOC (AUC, 0.9 1 <plus/minus> 0.04) and GFRP scores (AUC, 0.87 +/- 0.05). Analyzing litera ture and calculating AUCs from original data of previous studies, we observ ed that the superiority of the PRISM scare had never been demonstrated in m eningococcal diseases. Conclusions: The PRISM score performed better than the PIM score, and was n ot surpassed by specific scores. Thus, we propose its use for outcome predi ction in children with septic shock and purpura. However, if the PRISM scor e is to be used as inclusion criterion for clinical trials, it should be ev aluated within a few hours after admission.