<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1726-8958</journal-id>
<journal-title><![CDATA[Revista Médica La Paz]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Méd. La Paz]]></abbrev-journal-title>
<issn>1726-8958</issn>
<publisher>
<publisher-name><![CDATA[Colegio Médico de La Paz]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1726-89582025000200015</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[DESEMPEÑO DE ESCALAS PRONOSTICAS DE MORTALIDAD PEDIÁTRICA EN ALTITUD: ANÁLISIS COMPARATIVO E IMPLICANCIAS EN LA PRÁCTICA CLÍNICA DE TERAPIA INTENSIVA]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mattos Navarro]]></surname>
<given-names><![CDATA[Pablo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Zurita Padilla]]></surname>
<given-names><![CDATA[Jorge]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Caron Estrada]]></surname>
<given-names><![CDATA[Rosaura]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,CNS Hospital Materno Infantil ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af2">
<institution><![CDATA[,CNS Hospital Materno Infantil ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af3">
<institution><![CDATA[,UMSA  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Bolivia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<volume>31</volume>
<numero>2</numero>
<fpage>15</fpage>
<lpage>20</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.bo/scielo.php?script=sci_arttext&amp;pid=S1726-89582025000200015&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.bo/scielo.php?script=sci_abstract&amp;pid=S1726-89582025000200015&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.bo/scielo.php?script=sci_pdf&amp;pid=S1726-89582025000200015&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Objetivo: Comparar el desempeño de las escalas pronósticas PRISM, PIM-2 y PELOD en una Unidad de Cuidados Intensivos Pediátricos (UCIP) situada a 3600 metros sobre el nivel del mar, evaluando su capacidad para predecir la mortalidad en este entorno de gran altitud.  Métodos: Estudio observacional, analítico y prospectivo realizado en la UCIP del Hospital de Especialidades Materno Infantil en La Paz, Bolivia. Se incluyeron 201 pacientes pediátricos entre 1 mes y 18 años, admitidos entre noviembre de 2022 y diciembre de 2023. Se calcularon los puntajes PRISM, PIM-2 y PELOD para cada paciente. La capacidad discriminativa se evaluó mediante curvas ROC y área bajo la curva (AUC), mientras que la calibración se analizó con la prueba de Hosmer-Lemeshow.  Resultados: La mortalidad observada fue del 4.5% (IC 95%: 2.2-6.8%) y la incidencia de falla multiorgánica del 27% (IC 95%: 20.9-33.1%). PRISM mostró la mejor capacidad discriminativa (AUC 92%), seguido por PIM-2 (AUC 88.1%) y PELOD (AUC 86%). PRISM y PIM-2 presentaron buena calibración (p=0.49 y p=0.29 respectivamente), mientras que PELOD mostró una calibración deficiente (p&lt;0.001).  Conclusiones: En este entorno de gran altitud, PRISM demostró ser la escala más efectiva para predecir la mortalidad en la UCIP, seguida de cerca por PIM-2. PELOD, aunque con buena capacidad discriminativa, presentó una calibración inadecuada. Estos hallazgos son cruciales para optimizar la gestión de recursos y mejorar la calidad de atención en UCIPs ubicadas en regiones de gran altitud.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Aim:  To compare the performance of the PRISM, PIM-2, and PELOD prognostic scales in a Pediatric Intensive Care Unit (PICU) located 3600 meters above sea level and evaluate their ability to predict mortality in this high-altitude environment.  Study Design:  Observational, analytical, and prospective study conducted in the PICU of the Hospital de Especialidades Materno Infantil in La Paz, Bolivia. We included 201 pediatric patients between 1 month and 18 years, admitted between November 2022 and December 2023. PRISM, PIM-2, and PELOD scores were calculated for each patient. Discriminative ability was assessed by ROC curves and area under the curve (AUC), while calibration was analyzed with the Hosmer-Lemeshow test.  Results:  The observed mortality was 4.5% (95% CI: 2.2-6.8%) and the incidence of multiorgan failure was 27% (95% CI: 20.9-33.1%). PRISM showed the best discriminative ability (AUC 92%), followed by PIM-2 (AUC 88.1%) and PELOD (AUC 86%). PRISM and PIM-2 showed good calibration (p=0.49 and p=0.29 respectively), while PELOD showed poor calibration (p&lt;0.001).  Conclusions:  In this high altitude setting, PRISM proved to be the most effective scale for predicting PICU mortality, closely followed by PIM-2. PELOD, although with good discriminative ability, presented inadequate calibration. These findings are crucial for optimizing resource management and improving the quality of care in PICUs located in high-altitude regions.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Cuidados intensivos pediátricos]]></kwd>
<kwd lng="es"><![CDATA[escalas pronósticas]]></kwd>
<kwd lng="es"><![CDATA[PRISM]]></kwd>
<kwd lng="es"><![CDATA[PIM-2]]></kwd>
<kwd lng="es"><![CDATA[PELOD]]></kwd>
<kwd lng="es"><![CDATA[gran altitud]]></kwd>
<kwd lng="en"><![CDATA[pediatric intensive care]]></kwd>
<kwd lng="en"><![CDATA[prognostic scales]]></kwd>
<kwd lng="en"><![CDATA[PRISM]]></kwd>
<kwd lng="en"><![CDATA[PIM-2]]></kwd>
<kwd lng="en"><![CDATA[PELOD]]></kwd>
<kwd lng="en"><![CDATA[high altitude]]></kwd>
</kwd-group>
</article-meta>
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