Validation of the Pediatric Index of Mortality 3 in a Single Pediatric Intensive Care Unit in Korea
- PMID: 28049251
- PMCID: PMC5220006
- 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
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.
Conflict of interest statement
The authors have no potential conflicts of interest to disclose.
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References
-
- Garland A. Improving the ICU: part 1. Chest. 2005;127:2151–2164. - PubMed
-
- 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
-
- 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
-
- 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
-
- Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated pediatric risk of mortality score. Crit Care Med. 1996;24:743–752. - PubMed
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