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Validation of pediatric index of mortality-2 scoring system in a single pediatric intensive care unit in iran
Payman Salamati1, Saeed Talaee, Asgar Eghbalkhah
1Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
The Pediatric Index of Mortality-2 (PIM2) effectively predicts mortality in pediatric intensive care units (PICUs). Key factors influencing pediatric mortality include diagnosis, pupillary response, and length of stay.
Area of Science:
- Pediatric critical care medicine
- Clinical epidemiology
Background:
- The Pediatric Index of Mortality-2 (PIM2) is a scoring system used to predict mortality in pediatric intensive care units (PICUs).
- Validation of PIM2 is crucial for accurate risk assessment and resource allocation in diverse healthcare settings.
Purpose of the Study:
- To validate and calibrate the PIM2 score for children admitted to a specific pediatric intensive care unit.
- To assess the PIM2 score's performance in predicting mortality within the local context.
Main Methods:
- A prospective cohort study involving 240 patients admitted to the PICU between May 2007 and November 2008.
- Utilized PIM2 scoring, logistic regression, Receiver Operating Characteristic (ROC) curve analysis, and the Hosmer and Lemeshow goodness-of-fit test.
- Clinical measures were recorded upon PICU admission to compare expected versus observed mortality rates.
Main Results:
- The PIM2 model demonstrated adequate fit (P=0.741) with an Area Under the ROC Curve of 0.795, indicating good predictive accuracy.
- The standardized mortality ratio was 1.8, suggesting observed mortality was higher than predicted.
- High-risk diagnosis, pupillary reaction to light, and duration of PICU stay were significantly associated with pediatric mortality.
Conclusions:
- The PIM2 score is a reliable tool for predicting mortality in this pediatric intensive care unit.
- Factors such as admission risk category, pupillary light reflex, and length of hospitalization significantly impact pediatric mortality outcomes.
Objective:
A study to validate and calibrate Pediatric Index of Mortality-2 (PIM2) in children admitted to our pediatric intensive care unit (PICU).
Methods:
This is a prospective cohort study performed in Bahrami Children's Hospital affiliated to Tehran University of Medical Sciences. We studied the patients admitted to PICU from May 2007 to November 2008. Clinical measures were identified upon arrival in PICU. We used PIM2 score and logistic regression analysis to compare expected mortality risk with observed mortality rate. Receiver operating characteristics (ROC) curve analysis was done and standardized mortality ratio was calculated. PIM2 Index assessment was performed by use of Hosmer and Lemeshow goodness-of-fit test.
Findings:
240 patients were included in this study. The model fit was achieved adequately (P value=0.741). The area under the ROC curve was 0.795 (0.715-0.875 for 95% confidence interval) and standardized mortality ratio was 1.8 (1.28-2.465 for 95% confidence interval) High-risk group diagnosis with adjusted odds ratio (AOR)=14.75, pupil reaction to light (AOR=0.13) and duration of stay in PICU (AOR=1.03) had significant statistical association to pediatric mortality.
Conclusion:
PIM2 is a good index for prediction of mortality in our pediatric intensive care unit. This study revealed that there is significant statistical association between the children mortality and the length of hspita;ization, pupillary light reflex and the risk level category on admission.