Pediatric Index of Mortality 2 score in Italy: a multicenter, prospective, observational study

Area of Science:

• Pediatric critical care medicine
• Healthcare quality assessment
• Clinical scoring systems

Background:

• The Pediatric Index of Mortality 2 (PIM2) is a tool used to predict mortality in critically ill children.
• Assessing the performance of PIM2 in diverse populations is crucial for its accurate application.
• Italian pediatric intensive care units (PICUs) require validated tools for patient risk stratification.

Purpose of the Study:

• To evaluate the performance of the PIM2 score in Italian PICUs.
• To determine the discriminative and calibrative accuracy of PIM2 in a real-world setting.
• To provide data supporting the use of PIM2 for risk assessment in Italian pediatric patients.

Main Methods:

• Prospective, observational, multicenter study conducted over 1 year.
• Inclusion of 3266 consecutive patients aged 0-16 years across 18 Italian PICUs.
• Analysis of PIM2 score performance using discrimination (ROC curve) and calibration measures.

Main Results:

• The PIM2 score showed good discrimination, with an area under the ROC curve of 0.89 (95% CI 0.86-0.91).
• The scoring system demonstrated good calibration, with no significant differences between observed and predicted deaths across risk deciles (p = 0.26).
• Performance was consistent across the entire study population.

Conclusions:

• The PIM2 score is a well-performing tool for the Italian pediatric intensive care population.
• Reassessment of PIM2 in injury and postoperative patient groups may be beneficial in larger studies.
• The findings support the utility of PIM2 for risk stratification in Italian PICUs.