Assessment of suitability of pediatric index of mortality 2 score for monitoring the outcome of pediatric intensive care unit patients and associated risk factors of mortality in a tertiary care center in South India

Authors

  • Sreekrishna Y. Department of Pediatrics, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
  • Adarsh E. Department of Pediatrics, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
  • Lavanya T. S. Department of Pediatrics, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20212882

Keywords:

PIM 2 score, Discrimination, Calibration, SMR

Abstract

Background: Pediatric index of mortality 2 (PIM 2) score is an illness severity and scoring systems used for predicting outcome of children admitted to PICU. The objective was to evaluate the usefulness of PIM 2 score in predicting mortality in our PICU, assess whether the model is calibrated to our case mix and to compare the observed and expected death rates by calculating standardised mortality ratio. 

Methods: It was a prospective observational study done in a tertiary care center from January 2019 to June 2020. Consecutive 120 patients admitted to PICU aged from 1 month to 18 years were enrolled in study. PIM 2 scoring was calculated for the data obtained within 1 hour of admission to PICU. The outcome was recorded as death or discharge. PIM 2 logit score is calculated using software.

Results: PIM2 can discriminate between death and survival with area under curve (AUC) of 0.867 with 95% CI (0.729,0.980). PIM 2 predicted death rate was significant (p<0.001). The model is well calibrated with Hosmer- Lemeshow Goodness-of-fit test p=0.961 (p>0.05). The observed death rates are equal to predicted death rates and standardized mortality ratio (SMR) is equal to 1. 

Conclusions: PIM 2 score predicted mortality correlated well with observed mortality in PICU patients. The model is well calibrated for use in our set up and discriminate well between survivors and   non-survivors.

Author Biographies

Sreekrishna Y., Department of Pediatrics, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India

Professor, 

Department of Pediatrics

Adarsh E., Department of Pediatrics, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India

Professor, Head of the department

Department of Pediatrics

Lavanya T. S., Department of Pediatrics, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India

Resident, Pediatrics department

References

Nelson Textbook of Pediatrics, 21st edition.

Rogers Pediatric Intensive, Care, 4th edition.

Shann F, Pearson G, Slater A, Wilkinson K. Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med. 1997;23(2):201-7.

Slater A, Shann F, Pearson G. Paediatric Index of Mortality (PIM) Study Group. PIM2: A revised version of the Paediatric Index of Mortality. Intensive Care Med. 2003;29:278-85.

Slater A, Shann F, ANZICS Paediatric Study Group. The suitability of the pediatric index of mortality (PIM), PIM2, the pediatric risk of mortality (PRISM), and PRISM III for monitoring the quality of pediatric intensive care in Australia and New Zealand”. Pediatric Critical Care Med. 2004;5(5):447-54.

Shann F. Are we doing a good job: PRISM, PIM and all that. Intensive Care Med. 2002;28(2):105-7.

Pearson GA, Stickley J, Shann F. Calibration of the paediatric index of mortality in UK paediatric intensive care units. Arch Disease Childhood. 2001;84(2):125-8.

Wolfler A, Silvani P, Musicco M, Salvo I. Pediatric index of mortality 2 score in Italy: a multicenter, prospective, observational study. Intensive Care Med. 2007;33(8):1407-13.

Youssef MRL, Mosleh H, Labib JR. Assessment of the performance of the Pediatric Index of Mortality 2 (PIM2) among Egyptian pediatric patients admitted to the intensive care. Egyptian Pediatric Association Gazette. 2014;62:65-71.

Salamati P, Talaee S, Eghbalkhah A, Chaman R, Mokhtari Z, Azarshahin M. Validation of Pediatric Index of Mortality-2 Scoring System in a Single Pediatric Intensive Care Unit in Iran. Iran J Pediatr. 2012;22(4):481-6.

Sari DSP, Saputra I, Triratna S, Saleh I. The pediatric index of mortality 3 score to predict mortality in a pediatric intensive care unit in Palembang, South Sumatera, Indonesia. Paediatr Indones. 2017;57:164-70.

Eulmesekian PG, Perez A, Minces PG, Ferrero H. Validation of pediatric index of mortality 2 (PIM2) in a single pediatric intensive care unit of Argentina. Pediatr Crit Care Med. 2007;8:54-7.

Hariharan S, Krishnamurthy K, Grannum D. Validation of Pediatric Index of Mortality-2 scoring system in a pediatric intensive care unit, Barbados. J Trop Pediatr. 2011;57:9-13.

Tibby SM, Taylor D, Festa M, Hanna S, Hatherill M, Jones G et al. A comparison of three scoring systems for mortality risk among retrieved intensive care patients. Arch Dis Child. 2002;87:421-5.

Taori RN, Lahiri KR, Tullu MS. Performance of PRISM (Pediatric Risk of Mortality) score and PIM (Pediatric Index of Mortality) score in a tertiary care pediatric ICU. Indian J Pediatr. 2010;77:267-71.

Thukral A, Lodha R, Irshad M, Arora NK. Performance of Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality (PIM), and PIM-2 in a pediatric intensive care unit in a developing country. Pediatr Crit Care Med. 2006;7:356-61.

Qureshi AU, Ali AS, Ahmad TM. Comparison of three prognostic scores (PRISM, PELOD and PIM-2) at pediatric intensive care unit under Pakistani circumstances. J Ayub Med Coll Abbottabad. 2007;19:49-53.

Sankar J, Chandel A, Dubey NK, Sreenivas V, Sankar MJ. Do interventions in an ICU affect the predictive ability of pediatric index of mortality and pediatric index of mortality2 scores in a tertiary care hospital? Pediatric Cri Care Med. 2013;14(2):e70-6.

Hariharan S, Chen D, Merritt-Charles L. Risk-adjusted outcome evaluation in a multidisciplinary intensive care unit. West Indian Med J. 2007;56(3):240-5.

Sankar J, Singh J, Sankar MJ, Joghee S, Dewangan S, Dubey N. Pediatric Index of Mortality and PIM2 Scores Have Good Calibration in a Large Cohort of Children from a Developing Country. BioMed Res Int. 2014;907871.

Taori RN, Lahiri KR, Tullu MS. Performance of PRISM (Pediatric Risk of Mortality) Score and PIM (Pediatric Index of Mortality) Score in a Tertiary Care Pediatric ICU. Indian J Pediatr. 2014;77.

Sankar J, Chandel A, Dubey NK, Sreenivas V, Sankar MJ. Do interventions in an ICU affect the predictive ability of Pediatric index of mortality and Pediatric index of mortality-2 scores in a tertiary care hospital? Pediatr Crit Care Med. 2013;14:e70-6.

Gandhi J, Sangareddi S, Varadarajan P, Suresh S. Paediatric index of mortality 2 score as an outcome predictor in pediatric Intensive Care Unit in India. Indian J Crit Care Med. 2013;17(5):288-91.

Pollak MM. Pediatric risk of mortality (PRISM) score. Crit Care Med. 1988;16(11):1110-6.

Societe Francaise d’ Anesthesia et de Reanimation (SFAR). Scoring systems for ICU and surgical patients; PIM 2 (Paediatric Index of Mortality). 1997;23:201-7.

Lemeshow S, Hosmer DW. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol. 1982;115:92-106.

OpenEpi. Standardized Mortality Ratio and 95 Confidence Interval. Available at http://www.openepi.com/oe2.3/menu/ openepimenu.htm. Accessed on 12/1/2014.

Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiol. 1982;143:29-36.

Shukla VV, Nimbalkar SM, Phatak AG, Ganjiwale JD. Critical Analysis of PIM2 Score Applicability in a Tertiary Care PICU in Western India. Int J Pediatr. 2014;703942.

Taro Y. Statistics, An Introductory Analysis, 2nd Edition., New York: Harper and Row. 1976.

Netto AL, Muniz VM, Zandonade E, Maciel ELN, Bortolozzo RN, Costa NF et al. Performance of the Pediatric Index of Mortality 2 in a pediatric intensive care unit. Rev Bras Ter Intensiva. 2017;29(4):453-9.

Aroor S, Kumar S, Kini P, Mundkur S. Applicability of Paediatric Index of Mortality 2 Score to Predict Outcome in Children Admitted to Paediatric Intensive Care Unit. Paediatric Intensive Care Unit. J Nepal Paediatr Soc. 2018;38(3):149-52.

Ng DK, Miu T, Chiu W, Hui N, Chan C. Validation of pediatric index of mortality 2 in three pediatric intensive care units in Hong Kong. Indian J Pediatr. 2011;78(2):1491-4.

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Published

2021-07-23

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Original Research Articles