Sood M, Modi S, Sood I. Performance of PIM, PRISM, and PELOD scores in a resource-limited North Indian paediatric intensive care unit. World J Clin Pediatr 2026; 15(4): 120054 [DOI: 10.5409/wjcp.120054]
Corresponding Author of This Article
Mangla Sood, MD, Professor, Department of Pediatrics, Indira Gandhi Medical College, Ridge Sanjauli Road (Circular Road), Lakkar Bazar, Shimla 171001, Himāchal Pradesh, India. drmanglasood@gmail.com
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Sood M, Modi S, Sood I. Performance of PIM, PRISM, and PELOD scores in a resource-limited North Indian paediatric intensive care unit. World J Clin Pediatr 2026; 15(4): 120054 [DOI: 10.5409/wjcp.120054]
World J Clin Pediatr. Dec 9, 2026; 15(4): 120054 Published online Dec 9, 2026. doi: 10.5409/wjcp.120054
Performance of PIM, PRISM, and PELOD scores in a resource-limited North Indian paediatric intensive care unit
Mangla Sood, Shreya Modi, Ishaan Sood
Mangla Sood, Shreya Modi, Ishaan Sood, Department of Pediatrics, Indira Gandhi Medical College, Shimla 171001, Himāchal Pradesh, India
Co-first authors: Mangla Sood and Shreya Modi.
Author contributions: Sood M and Modi S were responsible for the initial study design, formulation of the research questions, and development of the study protocol as co-first authors; Modi S and Sood I conducted the clinical data collection within the paediatric intensive care unit, ensuring the rigorous recording of physiological variables within the required 1-hour and 24-hour windows, and drafted the initial manuscript, including the introduction, results, and discussion; Sood M provided clinical and academic oversight throughout the duration of the study. All authors contributed to the critical revision of the manuscript for final submission.
Institutional review board statement: The study protocol was reviewed and approved by the Institutional Ethics Committee of Indira Gandhi Medical College Shimla, Himachal Pradesh, No. HFW(MC-II)B(12)ETHICS/2024/8444.
Informed consent statement: Written informed consent was obtained from the parents or legal guardians of all participating children prior to their enrollment in the study. Confidentiality of patient data was strictly maintained throughout the study period.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The de-identified individual participant data underlying the results reported in this study will be made available to researchers, request can be directed to the corresponding author.
Corresponding author: Mangla Sood, MD, Professor, Department of Pediatrics, Indira Gandhi Medical College, Ridge Sanjauli Road (Circular Road), Lakkar Bazar, Shimla 171001, Himāchal Pradesh, India. drmanglasood@gmail.com
Received: February 13, 2026 Revised: April 7, 2026 Accepted: May 26, 2026 Published online: December 9, 2026 Processing time: 218 Days and 18.3 Hours
Abstract
BACKGROUND
Pediatric mortality prediction models are widely used in high-income nations but remain under-validated in resource-limited settings with different disease profiles and care resources. This study evaluated the performance of pediatric risk of mortality score III (PRISM-III), pediatric index of mortality-3 (PIM-3), and pediatric logistic organ dysfunction score-2 (PELOD-2) in predicting mortality in a resource limited paediatric intensive care unit.
AIM
To determine the discriminative ability and calibration of PRISM III, PIM-3, and PELOD-2 for predicting 30-day mortality.
METHODS
This was an observational study over 15 months and included 175 children aged 1 month to 18 years. Physiological variables were recorded within the first hour (PIM-3) and the first 24 hours (PRISM III, PELOD-2). Performance was measured using the area under the receiver operating characteristic curve for discrimination and the Hosmer-Lemeshow goodness-of-fit test for calibration.
RESULTS
The observed mortality rate in the cohort was 13.7% (24 deaths). Mortality was significantly associated with sepsis and the early requirement for mechanical ventilation or inotropes. All scores showed high negative predictive values (> 95%) and excellent calibration (Hosmer-Lemeshow P values: PRISM-III = 0.952, PIM-3 = 0.692, PELOD-2 = 0.518), with standardized mortality ratio of 1.04, indicating accurate overall mortality prediction. PIM-3 achieved the highest discrimination (area under the receiver operating characteristic 0.951), followed closely by PELOD-2 (0.939), while PRISM III performed lowest (0.884). PELOD-2 offered the highest sensitivity (87.5%).
CONCLUSION
All three scores fit the observed risk distribution well, demonstrating clinically acceptable discrimination and calibration for predicting mortality in the local patient population. However, the small number of mortality events limits the precision of these estimates and precludes claims of broader applicability.
Core Tip: Our findings confirm that paediatric intensive care unit mortality scores (pediatric index of mortality-3, pediatric risk of mortality score III, pediatric logistic organ dysfunction score-2) demonstrate acceptable discrimination and calibration for our low resource setting paediatric intensive care unit population (all Hosmer-Lemeshow P > 0.05; standardized mortality ratios 1.00-1.04). Pediatric index of mortality-3 achieved the highest discriminative ability (area under the receiver operating characteristic curve 0.951), outperforming pediatric logistic organ dysfunction score-2 (0.939) and pediatric risk of mortality score III (0.884), and coupled with a negative predictive value > 95%, represents the most practical choice for early risk stratification and efficient resource allocation within our center.
