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Validation of Pediatric Index of Mortality-2 scoring system in a pediatric intensive care unit, Barbados
Seetharaman Hariharan1, Kandamaran Krishnamurthy, Dionne Grannum
1Department of Clinical Surgical Sciences, The University of the West Indies, St. Augustine, Trinidad & Tobago. uwi.hariharan@gmail.com
Insights
This study assessed pediatric intensive care unit (PICU) patient outcomes in a developing nation using the Pediatric Index of Mortality-2 (PIM-2) scoring system. The PICU
Area of Science:
- Pediatric critical care medicine
- Healthcare outcomes research
- Epidemiology
Background:
- Pediatric intensive care units (PICUs) in developing countries face unique challenges.
- Accurate assessment of patient outcomes is crucial for quality improvement.
- The Pediatric Index of Mortality-2 (PIM-2) is a validated tool for predicting mortality in pediatric ICUs.
Purpose of the Study:
- To evaluate the performance of the PIM-2 scoring system in a PICU in a developing country.
- To assess the risk-adjusted outcomes of pediatric ICU patients.
- To compare the PICU's performance to international benchmarks.
Main Methods:
- Prospective study of 163 consecutive pediatric ICU patients.
- Data collection included demographics, diagnoses, PIM-2 scores, ICU stay duration, and hospital outcome.
- Calculation of predicted mortality, standardized mortality ratio (SMR), and assessment of PIM-2 calibration and discrimination.
Main Results:
- Respiratory and neurological illnesses were the most common admission diagnoses.
- The observed mortality rate was 5.5%, with a predicted mortality of 6.2% (SMR = 0.89).
- PIM-2 demonstrated good calibration (Hosmer-Lemeshow test) and discrimination (ROC curve AUC = 0.82).
Conclusions:
- The PIM-2 scoring system is a valid tool for assessing outcomes in this developing country's PICU.
- The PICU's performance is comparable to that of developed countries when risk-adjusted.
- This study supports the use of PIM-2 for quality monitoring and benchmarking in resource-limited settings.
Abstract:
This study evaluated the outcome of patients in a pediatric intensive care unit (ICU) of a developing country applying Pediatric Index of Mortality (PIM) version-2 scoring system. A total of 163 consecutive patients were prospectively studied. Data included demographics, diagnoses at admission, PIM-2 score, the duration of ICU stay and hospital outcome. Predicted mortality and standardized mortality ratio (SMR) were calculated. Respiratory and neurological illnesses were the main admission diagnoses. The mean length of stay was 5.4 [95% Confidence Intervals (CI): 4-6.9] days. The mean predicted mortality was 6.2% (95% CI: 4.3-8.1); the observed mortality rate was 5.5%, the SMR being 0.89. Hosmer-Lemeshow analysis calibrated PIM-2 for the case mix [χ(2) = 5.64 (df = 7), p = 0.58]. The area under the ROC curve was 0.82 (95% CI: 0.72-0.92) showing a good discriminant function. Performance of the pediatric ICU in Barbados is comparable to that of developed world by risk-adjusted outcome evaluation.
