Submitted by PPG Pediatria e Sa?de da Crian?a (pediatria-pg@pucrs.br) on 2019-03-12T12:24:17Z No. of bitstreams: 1 DISSERTA??O MariaRita Celiny 18_07_2018.pdf: 820907 bytes, checksum: 09346c615fe9651922e9d8fa8ab20b27 (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2019-03-18T11:12:08Z (GMT) No. of bitstreams: 1 DISSERTA??O MariaRita Celiny 18_07_2018.pdf: 820907 bytes, checksum: 09346c615fe9651922e9d8fa8ab20b27 (MD5) / Made available in DSpace on 2019-03-18T11:17:03Z (GMT). No. of bitstreams: 1 DISSERTA??O MariaRita Celiny 18_07_2018.pdf: 820907 bytes, checksum: 09346c615fe9651922e9d8fa8ab20b27 (MD5) Previous issue date: 2018-04-23 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Aims and Objectives: To evaluate the predictive capacity of Pediatric Risk of Mortality Score IV (PRISM IV) in a Pediatric Intensive Care Unit (PICU) in Southern Brazil. Secondarily compare this research to two other scores, Pediatric Index of Mortality (PIM) 2 and PIM 3 Methods: Longitudinal retrospective study, during one year, from January 1 to December 31, 2016. Children admitted to a PICU at a University Hospital in Southern Brazil. Patients older than 20 years and dying patients with vital signs incompatible with life after 2 hours of PICU admission were not included. Only the first entry into PICU during hospitalization was considered. Discrimination, calibration and comparison tests with other indexes and a PRISMIV / PIM2 concordance test were performed. The study was approved by the institution's ethics committee Results: There were 411 admissions in the year 2016, 378 patients were included in the study. Of these 378, 13 died, generating a mortality rate of 3.44%. PRISM IV estimated mortality of 3.18% with Standardised Mortality Ratio (SMR) of 1.08, zflora= -0.3. For the same sample, the PIM2 predicted a mortality of 2.78% and the PIM 3 of 2.51. In the same way, PIM 2 and PIM 3 presented SMR of 1.24 and 1.37, respectively, with zflora=-0.91 and -1.40. The Hosmer-Lemeshow (HL) adjustment test obtained a X? = 4,472 (p = 0.484) for PRISM IV. Similarly, the PIM 2 presented a good calibration with X? = 8,359 and p = 0.138. However, PIM 3 presented X?=16.013 and p = 0.007. The discrimination test with the area under the curve (AUC / ROC ? Receiver Operating Charateristic) of PRISM IV was 0.811 (95% CI 0.695-0.928). Similarly, the area of the PIM 2 was 0.779 (95% CI 0.645-0.913) and the PIM 3 obtained 0.759 (IC 95% 0.621-0.898). Among the three prognostic scores there was no statistical difference. The disagreement between the results of PRISM IV and PIM 2 was small. Conlusion: PRISM IV presented good predictive capacity in the study population, demonstrating good calibration and discrimination. In the comparative analysis, a similar predictive capacity was observed between this PRISM IV and PIM 2, which was not confirmed with PIM 3. It is suggested that PRISM IV be a validated tool for this population. / Objetivo: Avaliar a capacidade de predi??o do Pediatric Risk of Mortality Score IV (PRISM IV) em uma Unidade de Terapia Intensiva Pedi?trica (UTIP) no Sul do Brasil. Secundariamente comparar esta investiga??o a outros dois escores, Pediatric Index of Mortality (PIM) 2 e PIM 3. M?todos: Estudo retrospectivo longitudinal, de 01? de janeiro a 31 de dezembro de 2016 com crian?as admitidas em uma UTIP de um Hospital Universit?rio do Sul do Brasil. N?o foram inclu?dos pacientes com idade maior que 20 anos e pacientes moribundos, com sinais vitais incompat?veis com a vida ap?s 2 horas de admiss?o em UTIP. Apenas a primeira interna??o em UTIP durante a hospitaliza??o foi considerada. Foram realizados testes de discrimina??o, calibra??o e de compara??o com outros ?ndices e um teste de concord?ncia PRISM IV / PIM 2. O estudo foi aprovado pelo comit? de ?tica da institui??o. Resultados: Houveram 411 admiss?es no ano de 2016, 378 pacientes foram inclu?dos no estudo. Destes 378, 13 foram a ?bito, gerando uma taxa de mortalidade de 3,44%. O PRISM IV estimou mortalidade de 3,18% com Indice de Mortalidade Pad?o - (SMR) de 1,08, zflora= -0,31. Para a mesma amostra, o PIM 2 previu uma mortalidade de 2,78% e o PIM 3 de 2,51% e apresentaram SMR de 1,24 e 1,37, respectivamente, com valores para o zflora=-0,91 e -1,40. O teste de ajuste de Hosmer-Lemeshow (HL) obteve um X?=4,472 (p=0,484) para o PRISM IV. De forma semelhante, o PIM 2 apresentou boa calibra??o com X2=8,359 e p=0,138. Contudo, o PIM 3 apresentou X2=16,013 e p=0,007. O teste de discrimina??o com a ?rea abaixo da curva (AUC/ROC), do PRISM IV foi de 0,811 (IC95% 0,695-0,928). Por sua vez, a ?rea do PIM 2 foi de 0,779 (IC95% 0,645-0,913) e o PIM 3 obteve 0,759 (IC95% 0,621-0,898). Considerando a curva ROC, entre os tr?s escores progn?sticos n?o houve diferen?a estat?stica. A discord?ncia entre os resultados do PRISM IV e o PIM2 foi pequena. Conlus?o: O PRISM IV apresentou adequada capacidade preditiva na popula??o do estudo, demonstrando boa calibra??o e discrimina??o. Na an?lise comparativa observou-se semelhante capacidade preditiva entre este PRISM IV e PIM 2, o que n?o se confirmou com o PIM 3. O PRISM IV mostrou-se uma ferramenta validada para utiliza??o em UTIP no presente estudo.