Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Feb;32(2):365-370.
doi: 10.3346/jkms.2017.32.2.365.

Validation of the Pediatric Index of Mortality 3 in a Single Pediatric Intensive Care Unit in Korea

Affiliations

Validation of the Pediatric Index of Mortality 3 in a Single Pediatric Intensive Care Unit in Korea

Ok Jeong Lee et al. J Korean Med Sci. 2017 Feb.

Abstract

To compare mortality rate, the adjustment of case-mix variables is needed. The Pediatric Index of Mortality (PIM) 3 score is a widely used case-mix adjustment system of a pediatric intensive care unit (ICU), but there has been no validation study of it in Korea. We aim to validate the PIM3 in a Korean pediatric ICU, and extend the validation of the score from those aged 0-16 to 0-18 years, as patients aged 16-18 years are admitted to pediatric ICU in Korea. A retrospective cohort study of 1,710 patients was conducted in a tertiary pediatric ICU. To validate the score, the discriminatory power was assessed by calculating the area under the receiver-operating characteristic (ROC) curve, and calibration was evaluated by the Hosmer-Lemeshow goodness-of-fit (GOF) test. The observed mortality rate was 8.47%, and the predicted mortality rate was 6.57%. For patients aged < 18 years, the discrimination was acceptable (c-index = 0.76) and the calibration was good, with a χ² of 9.4 in the GOF test (P = 0.313). The observed mortality rate in the hemato-oncological subgroup was high (18.73%), as compared to the predicted mortality rate (7.13%), and the discrimination was unacceptable (c-index = 0.66). In conclusion, the PIM3 performed well in a Korean pediatric ICU. However, the application of the PIM3 to a hemato-oncological subgroup needs to be cautioned. Further studies on the performance of PIM3 in pediatric patients in adult ICUs and pediatric ICUs of primary and secondary hospitals are needed.

Keywords: Benchmarking; Child; Critical Care; Mortality; Risk Adjustment; Validation Study.

PubMed Disclaimer

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Calibration curves of the pediatric index of mortality 3 (PIM3). (A) PIM3, age group < 18 years. (B) PIM3, age group < 16 years. “Expected” hospital mortality (%) calculated by the PIM3 model and “observed” hospital mortality (%), together with the corresponding patient number, are presented. The patients were divided into 10 similar sized groups based on predicted mortality.

Similar articles

Cited by

References

    1. Garland A. Improving the ICU: part 1. Chest. 2005;127:2151–2164. - PubMed
    1. Pollack MM, Alexander SR, Clarke N, Ruttimann UE, Tesselaar HM, Bachulis AC. Improved outcomes from tertiary center pediatric intensive care: a statewide comparison of tertiary and nontertiary care facilities. Crit Care Med. 1991;19:150–159. - PubMed
    1. Marcin JP, Pollack MM. Review of the methodologies and applications of scoring systems in neonatal and pediatric intensive care. Pediatr Crit Care Med. 2000;1:20–27. - PubMed
    1. Straney L, Clements A, Parslow RC, Pearson G, Shann F, Alexander J, Slater A, ANZICS Paediatric Study Group and the Paediatric Intensive Care Audit Network Paediatric index of mortality 3: an updated model for predicting mortality in pediatric intensive care*. Pediatr Crit Care Med. 2013;14:673–681. - PubMed
    1. Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated pediatric risk of mortality score. Crit Care Med. 1996;24:743–752. - PubMed