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Performance of the Pediatric Index of Mortality 3 Score in PICUs in Argentina: A Prospective, National Multicenter
María Del P Arias López1, Nancy Boada2, Analía Fernández3
1Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina.
Insights
The Pediatric Index of Mortality 3 score effectively identified outcomes in Argentinian pediatric intensive care units (PICUs). However, observed deaths exceeded predictions, highlighting the need for updated scoring for international comparisons and service planning.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Biostatistics
Background:
- The Pediatric Index of Mortality 3 (PIM3) score is a tool for predicting mortality in pediatric intensive care units (PICUs).
- Validating PIM3 performance in diverse populations is crucial for accurate benchmarking and resource allocation.
Purpose of the Study:
- To evaluate the performance of the Pediatric Index of Mortality 3 (PIM3) score in a national cohort of children admitted to PICUs in Argentina.
- To assess the score's ability to predict mortality and compare observed versus predicted outcomes.
Main Methods:
- A prospective, national, multicenter study was conducted across 49 PICUs in Argentina.
- 6,602 children aged 1 month to 16 years admitted between May 2016 and February 2017 were enrolled.
- Statistical analysis included calculating the standardized mortality ratio and the area under the receiver operating characteristic curve (AUC).
Main Results:
- Observed mortality was 8%, while PIM3 predicted 6.16%.
- The standardized mortality ratio was 1.3 (95% CI, 1.20-1.42).
- The PIM3 score demonstrated good discrimination (AUC = 0.83) but significantly overestimated mortality (Hosmer-Lemeshow test, p < 0.001).
Conclusions:
- The PIM3 score adequately discriminated between survivors and non-survivors in the Argentinian PICU population.
- Observed mortality was higher than predicted, suggesting potential limitations of the score in this specific context.
- Implementing PIM3 can facilitate international comparisons of pediatric intensive care and aid in future service planning within Argentina.
Objective:
To assess the performance of the Pediatric Index of Mortality 3 score in a population of children admitted to PICUs in Argentina.
Design:
Prospective, national, multicenter study.
Setting:
Forty-nine PICUs located in Argentina belonging to public and private institutions.
Patients:
All children between 1 month and 16 years old admitted to the participating PICUs between May 15, 2016, and February 15, 2017.
Interventions:
None.
Measurement And Main Results:
A total of 6,602 patients were enrolled in the study. The observed mortality was 8% (531/6,602), whereas mortality predicted by Pediatric Index of Mortality 3 was 6.16% (407 deaths). The standardized mortality rate was 1.3 (95% CI, 1.20-1.42). The area under the receiver operating characteristic curve was 0.83 (95% CI, 0.82-0.85). The Hosmer-Lemeshow test showed that the difference between the mortality observed and the mortality predicted by Pediatric Index of Mortality 3 was statistically significant (χ, 135.63; p < 0.001).
Conclusions:
The Pediatric Index of Mortality 3 score adequately discriminated patients who died from those who survived in our population. However, the observed mortality was higher than predicted by the score. The use of an updated instrument such as Pediatric Index of Mortality 3 will allow an actual comparison between pediatric intensive care provided in the country and care provided internationally. This might also allow future planning of pediatric intensive care services in Argentina.
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