Download PDF
J Pediatr Intensive Care
DOI: 10.1055/s-0041-1740588
Original Article

Performance of Pediatric Index of Mortality in a Tertiary Care PICU in India

Nisha Toteja 
1   Department of Pediatrics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
,
Bharat Choudhary 
2   Department of Trauma and Emergency (Pediatrics), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Daisy Khera
3   Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Rohit Sasidharan
3   Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Prem Prakash Sharma 
4   Department of Community Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Kuldeep Singh 
3   Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Pediatric index of mortality-3 (PIM-3) is the latest update of one of the commonly used scoring systems in pediatric intensive care. It has free accessibility and is easy to use. However, there are some skepticisms regarding its practical usefulness in resource-limited settings. Hence, there is a need to generate region-specific data to evaluate its performance in different case mixes and resource constraints. The aim of the study is to evaluate the performance of the PIM-3 score in predicting mortality in a tertiary care PICU of a developing country. This was a retrospective cohort study. All children aged 1 month to 18 years admitted to the PICU during the study period from July 2016 to December 2018 were included. We reviewed the patient admission details and the case records of the enrolled. patients. Patient demographics, disease profile, co-morbidities, and PIM-3 scores were recorded along with the outcome. Area under receiver operating characteristics (AUROC) curves was used to determine discrimination. Standardized mortality ratio (SMR) and Hosmer Lemeshow goodness of fit were used to assess the calibration. Out of 282 children enrolled, 62 (21.9%) died. 58.5% of the patients were males, and 60% were less than 5 years of age. The principal diagnoses included respiratory and neurological conditions. The AUROC for PIM-3 was 0.961 (95% CI [0.93, 0.98]) and overall SMR was 1.28 (95% CI [0.96, 1.59]). Hosmer-Lemeshow goodness-of-fit was suggestive of poor calibration (χ 2 = 11.7, p < 0.05). We concluded that PIM-3 had good discrimination but poor calibration in our PICU setting.

Keywords

illness - outcomes - prognosis - scoring system - PIM-3 - mortality - PICU

Supplementary Material



Publication History

Received: 27 May 2021

Accepted: 12 November 2021

Article published online:
23 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Marcin JP, Pollack MM. Review of the methodologies and applications of scoring systems in neonatal and pediatric intensive care. Pediatr Crit Care Med 2000; 1 (01) 20-27
    CrossrefPubMedGoogle Scholar
  • 2 Gulla KM, Sachdev A. Illness severity and organ dysfunction scoring in pediatric intensive care unit. Indian J Crit Care Med 2016; 20 (01) 27-35
    CrossrefPubMedGoogle Scholar
  • 3 Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated pediatric risk of mortality score. Crit Care Med 1996; 24 (05) 743-752
    CrossrefPubMedGoogle Scholar
  • 4 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. Pediatr Crit Care Med 2004; Sep; 5 (05) 447-454
    CrossrefPubMedGoogle Scholar
  • 5 Leteurtre S, Martinot A, Duhamel A. et al. Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet 2003; 362 (9379): 192-197
    CrossrefPubMedGoogle Scholar
  • 6 Leteurtre S, Martinot A, Duhamel A. et al. Development of a pediatric multiple organ dysfunction score: use of two strategies. Med Decis Making 1999; 19 (04) 399-410
    CrossrefPubMedGoogle Scholar
  • 7 Pollack MM, Holubkov R, Funai T. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. The pediatric risk of mortality score: update 2015. Pediatr Crit Care Med 2016; 17 (01) 2-9
    CrossrefPubMedGoogle Scholar
  • 8 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 (02) 49-53
    PubMedGoogle Scholar
  • 9 Choi K, Ng D, Wong S, Kwok K, Chow P, Chan C. et al. Assessment of the Pediatric Index of Mortality (PIM) and the Pediatric Risk of Mortality (PRISM) III score for prediction of mortality in a pediatric intensive care unit in Hong Kong. Hong Kong Med J 2005; 11 (02) 97
    PubMedGoogle Scholar
  • 10 Patki VK, Raina S, Antin JV. Comparison of severity scoring systems in a pediatric intensive care unit in India: a single-center prospective, observational cohort study. J Pediatr Intensive Care 2017; Jun; 6 (02) 098-102
    PubMedGoogle Scholar
  • 11 Garcia PC, Ronchetti MR, Da Costa CA. et al. Abstract P-340: the pediatric risk of mortality iv (PRISM IV) validation in an independent sample in southern of Brazil. Pediatr Crit Care Med 2018; 19 (6S): 150
    CrossrefPubMedGoogle Scholar
  • 12 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 (03) 267-271
    CrossrefPubMedGoogle Scholar
  • 13 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; 2014: 703942
    CrossrefPubMedGoogle Scholar
  • 14 Sankar J, Singh A, 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; 2014: 907871
    CrossrefPubMedGoogle Scholar
  • 15 Straney L, Clements A, Parslow RC. et al; ANZICS Paediatric Study Group and the Paediatric Intensive Care Audit Network. Paediatric index of mortality 3: an updated model for predicting mortality in pediatric intensive care*. Pediatr Crit Care Med 2013; 14 (07) 673-681
    CrossrefPubMedGoogle Scholar
  • 16 Jung JH, Sol IS, Kim MJ, Kim YH, Kim KW, Sohn MH. Validation of pediatric index of mortality 3 for predicting mortality among patients admitted to a pediatric intensive care unit. Acute Crit Care 2018; 33 (03) 170-177
    CrossrefPubMedGoogle Scholar
  • 17 Lee OJ, Jung M, Kim M, Yang H-K, Cho J. Validation of the pediatric index of mortality 3 in a single pediatric intensive care unit in Korea. J Korean Med Sci 2017; 32 (02) 365-370
    CrossrefPubMedGoogle Scholar
  • 18 Abdelkader A, Shaaban M, Zahran M. Using two scores for the prediction of mortality in pediatric intensive care units. Al-Azhar Assiut Med J 2018; 16 (04) 349
    CrossrefPubMedGoogle Scholar
  • 19 Tyagi P, Tullu MS, Agrawal M. Comparison of pediatric risk of mortality III, pediatric index of mortality 2, and pediatric index of mortality 3 in predicting mortality in a pediatric intensive care unit. J Pediatr Intensive Care 2018; 7 (04) 201-206
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Poddar B, Naranje K, Gurjar M, Singh RK, Azim A, Baronia AK. Performance of PIM 2 and PIM 3 scores in a single, tertiary care combined Indian ICU. Pediatr Crit Care Med 2014; 15: 156
    CrossrefPubMedGoogle Scholar
  • 21 Sankar J, Gulla KM, Kumar UV, Lodha R, Kabra SK. Comparison of outcomes using pediatric index of mortality (PIM) -3 and PIM-2 models in a pediatric intensive care unit. Indian Pediatr 2018; 55 (11) 972-974
    CrossrefPubMedGoogle Scholar
  • 22 Zou KH, O'Malley AJ, Mauri L. Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models. Circulation 2007; 115 (05) 654-657
    CrossrefPubMedGoogle Scholar
  • 23 Muttalib F, Clavel V, Yaeger LH, Shah V, Adhikari NKJ. Performance of pediatric mortality prediction models in low- and middle-income countries: a systematic review and meta-analysis. J Pediatr 2020; 225: 182-192.e2
    CrossrefPubMedGoogle Scholar
  • 24 Honna L, Triratna S, Triwani T, Theodorus T. Use of pediatric logistic organ dysfunction in determining prognosis among pediatric intensive care unit patients. Paediatr Indones 2016; 50 (06) 347-350
    CrossrefPubMedGoogle Scholar
  • 25 Gandhi J, Sangareddi S, Varadarajan P, Suresh S. Pediatric index of mortality 2 score as an outcome predictor in pediatric intensive care unit in India. Indian J Crit Care Med 2013; 17 (05) 288-291
    CrossrefPubMedGoogle Scholar
  • 26 Wolfler A, Osello R, Gualino J. et al; Pediatric Intensive Therapy Network (TIPNet) Study Group. Pediatric Intensive Therapy Network (TIPNet) Study Group. The importance of mortality risk assessment: validation of the pediatric index of mortality 3 score. Pediatr Crit Care Med 2016; 17 (03) 251-256
    CrossrefPubMedGoogle Scholar
  • 27 Sari DSP, Saputra I, Triratna S, Saleh Mgs 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 (03) 164-170
    PubMedGoogle Scholar
  • 28 Flaatten H. The present use of quality indicators in the intensive care unit. Acta Anaesthesiol Scand 2012; 56 (09) 1078-1083
    CrossrefPubMedGoogle Scholar
  • 29 Raghavendra Bhupal YJ, Patil VD, Bellad RM, Mahanthshetti NS. A prospective cohort study for the comparison of two prognostic scores—PRISM 3 and PIM 2 in a pediatric intensive care unit. J Evol Med Dent Sci 2014; 45: 10954-10966
    PubMedGoogle Scholar
  • 30 Thukral A, Lodha R, Irshad M, Arora NK. Performance of Pediatric Risk of Mortality (PRISM), pediatric index of mortality (PIM), and PIM2 in a pediatric intensive care unit in a developing country. Pediatr Crit Care Med 2006; 7 (04) 356-361
    CrossrefPubMedGoogle Scholar
  • 31 Labib Youssef MR, Mosleh H, Rene Labib J. Assessment of the performance of the Pediatric Index of Mortality 2 (PIM2) among Egyptian pediatric patients admitted to the intensive care. Egypt Pediatr Assoc Gaz 2014; 62: 65-71
    CrossrefPubMedGoogle Scholar
  • 32 Ciofi degli Atti ML, Cuttini M, Ravà L. et al. Performance of the pediatric index of mortality 2 (PIM-2) in cardiac and mixed intensive care units in a tertiary children's referral hospital in Italy. BMC Pediatr 2013; 13 (01) 100
    CrossrefPubMedGoogle Scholar
  • 33 Eulmesekian PG, Pérez 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 (01) 54-57
    CrossrefPubMedGoogle Scholar
  • 34 Malhotra D, Nour N, El Halik M, Zidan M. Performance and analysis of pediatric index of mortality 3 score in a pediatric ICU in Latifa Hospital, Dubai, UAE. Dubai Med J 2019; ; 13; 3 (01) 19-25
    CrossrefPubMedGoogle Scholar
  • 35 Niederwanger C, Varga T, Hell T. et al. Comparison of pediatric scoring systems for mortality in septic patients and the impact of missing information on their predictive power: a retrospective analysis. PeerJ 2020; 8: e9993
    CrossrefPubMedGoogle Scholar