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Paediatric index of mortality 3: an updated model for predicting mortality in pediatric intensive care*
Lahn Straney1, Archie Clements, Roger C Parslow
11School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. 2School of Population Health, The University of Queensland, Brisbane, QLD, Australia. 3Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, United Kingdom. 4Birmingham Children's Hospital, Birmingham, United Kingdom. 5Royal Children's Hospital, Melbourne, VIC, Australia. 6Australian and New Zealand Intensive Care Society, Brisbane, QLD, Australia. 7Royal Children's Hospital, Brisbane, QLD, Australia.
Insights
The Paediatric Index of Mortality 3 (PICU) is a new tool to predict child mortality in intensive care units. This updated model offers an international standard for risk-adjusted mortality assessment in pediatric critical care.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Epidemiology
Background:
- Accurate risk stratification is crucial for comparing outcomes in pediatric intensive care units (PICUs).
- Existing mortality prediction models require regular updates to reflect contemporary patient populations and care standards.
Purpose of the Study:
- To develop and validate an updated prediction model for mortality risk in children admitted to PICUs.
- To provide an international standard for risk-adjusted mortality assessment, improving upon the Paediatric Index of Mortality 2.
Main Methods:
- An international, multicenter, prospective cohort study involving 60 PICUs across Australia, New Zealand, Ireland, and the United Kingdom.
- Analysis included 53,112 pediatric admissions (age < 18) from 2010-2011, excluding those transferred between ICUs.
- A logistic regression model was developed, with variable selection based on statistical significance and model performance.
Main Results:
- The revised prediction model demonstrated good discriminatory performance, with an overall area under the curve (AUC) of 0.88.
- The model performed better in Australia and New Zealand (AUC 0.91) compared to the United Kingdom and Ireland (AUC 0.85).
- The final model showed good overall fit and discriminatory power for predicting mortality in pediatric ICU admissions.
Conclusions:
- The Paediatric Index of Mortality 3 (PICU 3) offers a validated, international standard for assessing risk-adjusted mortality in pediatric intensive care.
- This updated model, based on a large, contemporary dataset, facilitates more accurate comparisons of outcomes across different PICUs globally.
- PICU 3 is essential for benchmarking and quality improvement initiatives in pediatric critical care settings.
Objectives:
To provide an updated version of the Paediatric Index of Mortality 2 for assessing the risk of mortality among children admitted to an ICU.
Design:
International, multicenter, prospective cohort study.
Setting:
Sixty ICUs that accept pediatric admissions in Australia, New Zealand, Ireland, and the United Kingdom.
Patients:
All children admitted in 2010 and 2011 younger than 18 years old at the time of admission and either died in ICU or were discharged. Patients who were transferred to another ICU were not included. Fifty-three thousand one hundred twelve patient admissions were included in the analysis.
Interventions:
None.
Measurement And Main Results:
A revised prediction model was built using logistic regression. Variable selection was based on significance at the 95% level and overall improvement of the model's discriminatory performance and goodness of fit. The final model discriminated well (area under the curve, 0.88, 0.88-0.89); however, the model performed better in Australia and New Zealand than in the United Kingdom and Ireland (area under the curve was 0.91, 0.90-0.93 and 0.85, 0.84-0.86, respectively).
Conclusions:
Paediatric Index of Mortality 3 provides an international standard based on a large contemporary dataset for the comparison of risk-adjusted mortality among children admitted to intensive care.