ABSTRACT
Our study has been carried out in intensive care unit [ICU] at Nasser Institute under supervision of Pediatric oncology specialists from Jan 2000 to Oct. 2003. It has included 49 children [29 males and 20 females] with childhood malignancies with mean age 5 years to evaluate the paediatric risk of mortality [PRISM] as a scoring 10 +/- 5 systems for prediction of outcome in PICU of children with malignancies. This score and presence of organ system failure [OSFs] were done for all patients on the first day of admission. Our results owed that the duration of hospital stay was, and days among all admission, survivors and non survivors respectively. Sex and age had no effect on survival rate and the duration of hospital stay. Also our results revealed that 35 [71.43%] of study cases had haematological malignancies, 8 [16.33%] intracranial tumors and [12.24%] extracranial solid tumors. The mean PRISM score was [15.17.76, 19.425.02, 6.193.62] among admissions, non survivors and survivors respectively and the difference between survivors and non survivors was statistically highly significant [p<0.01]. As regards the causes of admission to PICU these included respiratory failure, CNS problems, septic shock and haematological and renal problems [15, 15, 13 and 6] respectively, with mortality rate 33.3%, 18.2%, 36.4% and 12,1% respectively of total mortality with higher mortalities among septic shock patients. The total mortalities were 33 [67.3%] and the survival 16 [32.7%] and it was correlated significantly with OSFs. Both CVS and RS failures had the greatest effect on MR [100%] when any one developed as a part of Organ System Failure [OSF]s. The need for mechanical ventilation or inotropic support correlated with poorer outcome it was 85% and 92.9% respectively. The PRISM score had significant correlation with OSFs particularly heart and respiratory systems failure. We can conclude that the PRISM score is highly recommended for evaluation of PICU performance with other standard one, early admission to PICU for early prediction, proper therapeutic intervention and prevention of OSFs with subsequently reduction of MR, cost and over utilized ICU resources, also infection control strategies should be strictly applied for control of infection and sepsis