Comparison of three different timeframes for pediatric index of mortality data collection in transported intensive
Sarfaraz Rahiman1, Kalaimaran Sadasivam, Deborah A Ridout
11Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, United Kingdom. 2Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, United Kingdom. 3Departments of Neurology and Anaesthesia (Pediatrics), Boston Children's Hospital and Harvard Medical School, Boston, MA. 4Children's Acute Transport Service, Great Ormond Street Hospital, London, United Kingdom.
Insights
This study found no difference in Pediatric Index of Mortality-2 scores when data was collected at different times for pediatric intensive care unit (PICU) transport patients. Uniform data collection simplifies scoring and improves quality.
Area of Science:
- Pediatric critical care medicine
- Healthcare quality improvement
- Clinical informatics
Background:
- The Pediatric Index of Mortality-2 (PIM-2) is a severity of illness score used to predict mortality in pediatric intensive care units (PICUs).
- Accurate data collection is crucial for reliable PIM-2 scoring, especially for critically ill children transported by specialist teams.
Purpose of the Study:
- To determine the optimal timeframe for collecting Pediatric Index of Mortality-2 (PIM-2) data in patients transferred to PICUs by specialist teams.
- To compare PIM-2 scores calculated using data from different time points: standard, retrieval, and admission.
Main Methods:
- Retrospective cohort study of 759 children transported to a tertiary PICU in London between 2007 and 2008.
- Compared PIM-2 scores calculated using standard, retrieval, and admission timeframes.
- Analyzed data completeness, discrimination, and calibration of PIM-2 scores.
Main Results:
- Missing data for PIM-2 variables occurred in up to 42.7% of transported admissions, persisting even after 1 hour in PICU.
- PIM-2 scores did not change significantly across the different timeframes.
- All PIM-2 calculations showed good discrimination (AUC ≥ 0.77), but only retrieval and standard timeframes demonstrated good calibration.
Conclusions:
- The study does not support different timeframes for PIM-2 data collection in transported versus direct PICU admissions.
- A uniform scoring procedure for PIM-2 may simplify data collection and enhance data quality.
- Standardizing PIM-2 data collection can improve its utility in assessing pediatric critical care outcomes.
Objective:
To identify the most appropriate timeframe for Pediatric Index of Mortality-2 data collection in patients transported to PICUs by specialist teams.
Design:
Retrospective cohort study.
Setting:
A regional PICU transport team in London, United Kingdom.
Patients:
Children admitted for intensive care to a tertiary children's hospital PICU following transport by a PICU transport team between January 1, 2007, and December 31, 2008.
Interventions:
None.
Measurements And Main Results:
Data on case mix and outcome from children transferred to the tertiary PICU during the study period were analyzed. The "standard" timeframe used in calculating Pediatric Index of Mortality-2 was compared with Pediatric Index of Mortality-2 calculated using data from two other 1-hour timeframes (during "retrieval" and during "admission"). A total of 759 transported admissions were studied. Eighty-three children died (mortality rate, 10.9%). Data were missing in up to 42.7% of admissions for some Pediatric Index of Mortality-2 variables from transport. However, missing data persisted even after the first hour of PICU admission in most cases. There was significant improvement in some physiological variables following transport (p < 0.01), but Pediatric Index of Mortality-2 did not change significantly. Pediatric Index of Mortality-2 from all three timeframes exhibited good discrimination (area under the receiver-operating characteristic curve ≥ 0.77). Calibration across deciles of mortality risk was poor for the "admission" Pediatric Index of Mortality-2 (Hosmer-Lemeshow goodness-of-fit test p = 0.04) but good for the other two calculated Pediatric Index of Mortality-2 models (p > 0.20).
Conclusions:
The findings of our single-center study do not support the need for different timeframes for Pediatric Index of Mortality-2 data collection in transported and direct PICU admissions. Uniformity in scoring procedure may simplify data collection and improve data quality.
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