Performance of PRISM III and pediatric early warning score for predicting patients needing increased level of care in a pediatric intermediate care unit.

The aim of this study is to evaluate the performance of PRISM III and pediatric early warning score (PEWS) for predicting increased level of care in an intermediate care unit (IMCU) and to describe the factors associated with it. This was a retrospective observational study in an IMCU of a tertiary university hospital without an on-site pediatric intensive care unit (PICU). Patients younger than 14 years old admitted to IMCU (June 2021 to September 2024) were included. Area under the curve (AUC) for "increased level of care"-composite outcome including high respiratory support, invasive procedures, prolonged length of stay, or PICU-transfer-was calculated for both scores. Of 567 patients included (median age 15 months [IQR 3-49]; 57.8% male), 269 (47.4%) needed increased level of care. AUC of PRISM III was 0.545 (CI95% 0.497-0.592), whereas AUC of PEWS was 0.697 (CI95% 0.654-0.740); sensitivity was 43.5% (CI95% 37.8-49.3) and specificity was 86.6% (CI95% 82.3-90.1). Results were consistent in sensitivity analyses. Healthcare workers or family concern was associated with increased level of care [aOR 4.127 (CI95% 2.492-6.835)] and PICU-transfer [aOR 8.180 (CI95% 2.920-22.912)].

conclusionsNeither PRISM III nor PEWS was accurate to predict increased level of care in IMCU. Healthcare worker or family concern was associated with both increased level of care and PICU-transfer. These findings highlight the need for IMCU-specific severity tools and the importance of individual assessment. WHAT IS KNOWN: • Early warning scores (PEWS) and PRISM III are widely used in general wards and PICU, respectively. • However, their performance in intermediate care units (IMCU) remains poorly defined. WHAT IS NEW: • Both PRISM III and PEWS have limited accuracy in predicting the need for increased level of care within an IMCU. • The subjective concern of staff or family members was associated with clinical worsening and PICU-transfer.