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Critical Analysis of PIM2 Score Applicability in a Tertiary Care PICU in Western India
Vivek V Shukla1, Somashekhar M Nimbalkar2, Ajay G Phatak3
1Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat 388325, India.
Insights
The Pediatric Intensive Care Unit (PICU) study found infectious diseases common in Indian children. The PIM2 score inadequately predicted mortality, indicating a need for recalibration and adherence to PALS/GEM guidelines for better outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Epidemiology
- Clinical Outcomes Research
Background:
- Children possess limited physiological reserves, making them vulnerable to rapid deterioration.
- Understanding patient profiles and predictive scoring tool applicability is crucial for optimizing care in Pediatric Intensive Care Units (PICUs).
Purpose of the Study:
- To profile patients admitted to a PICU in India.
- To assess the applicability and predictive accuracy of the PIM2 (Pediatric Index of Mortality 2) score in the Indian setting.
Main Methods:
- A prospective observational study was conducted on 742 consecutive PICU admissions.
- Patient demographics, diagnoses, interventions, and outcomes were recorded.
- The PIM2 score's sensitivity and specificity were evaluated using Receiver Operating Characteristic (ROC) curve analysis and logistic regression.
Main Results:
- Infectious diseases, including septicemia, septic shock, pneumonia, meningitis, and encephalitis, were the most common admissions (29.6% to 17.2%).
- The PIM2 score showed moderate predictive accuracy (Area Under Curve: 0.724) but its contribution to predicting mortality was found to be meager.
- Logistic regression analysis indicated that adherence to Pediatric Advanced Life Support (PALS) and Guidelines for Essential Measures (GEM) was associated with improved outcomes.
Conclusions:
- Infectious diseases are the primary drivers of PICU admissions and mortality in this Indian cohort.
- The PIM2 scoring system requires recalibration for the Indian population due to inadequate outcome prediction.
- Implementing PALS/GEM guidelines may enhance patient outcomes in PICU settings.
Abstract:
Objective. Children have limited physiological reserve that deteriorates rapidly. Present study profiled patients admitted to PICU and determined PIM2 score applicability in Indian setting. Patients and Methods. Prospective observational study. Results. In 742 consecutive admissions, male : female ratio was 1.5 : 1, 35.6% patients were ventilated, observed mortality was 7%, and 26.4% were <1 year. The profile included septicemia and septic shock (29.6%), anemia (27.1%), pneumonia (19.6%), and meningitis and encephalitis (17.2%). For the first year, sensitivity of PIM2 was 65.8% and specificity was 71% for cutoff value at 1.9 by ROC curve analysis. The area under the curve was 0.724 (95% CI: 0.69, 0.76). This cutoff was validated for second year data yielding similar sensitivity (70.6%) and specificity (65%). Logistic regression analysis (LRA) over entire data revealed various variables independently associated with mortality along with PIM2 score. Another logistic model with same input variables except PIM2 yielded the same significant variables with Nagelkerke R square of 0.388 and correct classification of 78.5 revealing contribution of PIM2 in predicting mortality is meager. Conclusion. Infectious diseases were the commonest cause of PICU admission and mortality. PIM2 scoring did not explain the outcome adequately, suggesting need for recalibration. Following PALS/GEM guidelines was associated with better outcome.
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