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Performance of Pediatric Index of Mortality PIM-3 in a Tertiary Care PICU in India

Nisha Toteja1, Bharat Choudhary2, Daisy Khera3

  • 1Department of Pediatrics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India.

Journal of Pediatric Intensive Care
|December 4, 2024
PubMed

Insights

The Pediatric Index of Mortality-3 (PIM-3) score shows strong predictive ability for mortality in pediatric intensive care units. However, its calibration was poor in a developing country

Area of Science:

  • Pediatric critical care medicine
  • Health services research
  • Clinical epidemiology

Background:

  • The Pediatric Index of Mortality-3 (PIM-3) is a widely used scoring system for pediatric intensive care.
  • Concerns exist regarding PIM-3's utility in resource-limited settings.
  • Region-specific data are needed to assess PIM-3 performance across diverse populations and healthcare constraints.

Purpose of the Study:

  • To evaluate the performance of the PIM-3 score in predicting mortality.
  • To assess PIM-3's accuracy in a tertiary care Pediatric Intensive Care Unit (PICU) in a developing country.

Main Methods:

  • Retrospective cohort study including children aged 1 month to 18 years admitted to the PICU.
  • Data collected included demographics, disease profiles, comorbidities, PIM-3 scores, and outcomes.
  • Statistical analysis involved Area Under the Receiver Operating Characteristic (AUROC) curves for discrimination and Standardized Mortality Ratio (SMR) with Hosmer-Lemeshow goodness of fit for calibration.

Main Results:

  • A total of 282 children were included, with 62 (21.9%) deaths.
  • The PIM-3 score demonstrated excellent discrimination with an AUROC of 0.961.
  • However, the PIM-3 score exhibited poor calibration, as indicated by the Hosmer-Lemeshow test (χ² = 11.7, p < 0.05) and an SMR of 1.28.

Conclusions:

  • The PIM-3 score possesses strong discriminatory power for predicting mortality in this PICU.
  • Despite good discrimination, the PIM-3 score showed poor calibration in the context of a developing country's tertiary care PICU.
  • Further research may be needed to refine or adapt scoring systems for resource-limited settings.

Keywords:
PICUPIM-3illnessmortalityoutcomesprognosisscoring system

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