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[Application of the Pediatric Index of Mortality 2 in pediatric patients with complex chronic conditions]

Jaisson G da Fonseca1, Alexandre R Ferreira1

  • 1Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.

Jornal De Pediatria
|May 13, 2014
PubMed

Insights

The Pediatric Index of Mortality 2 (PIM2) demonstrated poor performance in predicting mortality for critically ill children with complex chronic conditions (CCCs). Further research is needed to validate PIM2 in diverse pediatric intensive care unit (PICU) populations.

Area of Science:

  • Critical Care Medicine
  • Pediatric Health Outcomes
  • Biostatistics

Context:

  • The Pediatric Index of Mortality 2 (PIM2) is a widely used severity scoring system for pediatric intensive care units (PICUs).
  • Assessing the performance of PIM2 is crucial, especially in PICUs with a high prevalence of patients with complex chronic conditions (CCCs).
  • Understanding PIM2's accuracy in this specific population is vital for resource allocation and clinical decision-making.

Purpose:

  • To evaluate the performance of the Pediatric Index of Mortality 2 (PIM2) in a Brazilian PICU.
  • To compare PIM2's performance in pediatric patients with and without complex chronic conditions (CCCs).
  • To assess both the discriminative and calibration abilities of PIM2 in this cohort.

Summary:

  • A prospective cohort study included 677 patients admitted to a PICU between 2009 and 2011; 83.9% had CCCs.
  • PIM2 showed adequate discrimination overall (AUC 0.840) and in subgroups, but poor calibration in the general population and CCC patients.
  • Mortality was higher in CCC patients (10.3%) versus non-CCC patients (6.4%), but PIM2 did not significantly differ in predicted mortality between groups.

Impact:

  • The PIM2 demonstrated suboptimal performance in predicting mortality for pediatric patients with complex chronic conditions.
  • The findings suggest that PIM2's utility may be limited in PICUs with a high burden of complex chronic conditions.
  • Further validation of PIM2 in diverse PICU populations, particularly those with high CCC prevalence, is warranted.
Abstract

Keywords:
ChildChronic diseaseCriançaCuidado intensivoDoença crônicaIndex of disease severityIntensive careMortalidadeMortalityÍndice de gravidade da doença

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