Comparison of Pediatric Risk of Mortality III, Pediatric Index of Mortality 2, and Pediatric Index of Mortality 3 in Predicting Mortality in a Pediatric Intensive Care Unit

Abstract

Aims To compare and validate the Pediatric Risk of Mortality (PRISM) III, Pediatric Index of Mortality (PIM) 2, and PIM 3 scores in a tertiary care pediatric intensive care unit (PICU) (Indian setting).

Materials and Methods All consecutively admitted patients in the PICU of a public hospital (excluding those with unstable vital signs or cardiopulmonary resuscitation within 2 hours of admission, cardiopulmonary resuscitation before admission, and discharge or death in less than 24 hours after admission) were included. PRISM III, PIM 2, and PIM 3 scores were calculated. Mortality discrimination for the three scores was calculated using the receiver operating characteristic (ROC) curve, and calibration was performed using the Hosmer–Lemeshow goodness-of-fit test.

Results A total of 350 patients were included (male:female = 1.3:1) over the study duration of 18 months (median age: 12 months [interquartile range: 4–60 months]). Nearly half were infants (47.4%). Patients with central nervous system disease were the highest (22.8%) followed by cardiovascular system (20.6%). Mortality rate was 39.4% (138 deaths). The area under the ROC curve for the PRISM III score was 0.667, and goodness-of-fit test showed no significant difference between the observed and expected mortalities in any of these categories (p > 0.5), showing good calibration. Areas under the ROC curve for the PIM 2 and PIM 3 scores were 0.728 and 0.726, respectively. For both the scores, the goodness-of-fit test showed good calibration.

Conclusions Although all the three scores demonstrate good calibration, the PIM 2 and PIM 3 scores have an advantage regarding the better discrimination ability, ease of data collection, simplicity of computation, and inherent capacity of not being affected by treatment in PICU.

Keywords

death - ICU - mortality - pediatric - PRISM - PIM score

Author Contributions

Dr. Priyamvada Tyagi was involved in the conceptualization of the manuscript, collecting patient data, conducting literature search, and drafting the manuscript. Dr. Milind S. Tullu and Dr. Mukesh Agrawal were involved in the conceptualization of the manuscript, supervising the data collection, conducting literature search, and revising the manuscript. Dr. Milind S. Tullu acted as the guarantor of the manuscript.

• References

• 1 Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 1996; 24 (05) 743-752
• 2 Slater A, Shann F, Pearson G. ; Paediatric Index of Mortality (PIM) Study Group. PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med 2003; 29 (02) 278-285
• 3 Straney L, Clements A, Parslow RC. , et al; 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 (07) 673-681
• 4 Taori RN, Lahiri KR, Tullu MS. Performance of PRISM (Pediatric Risk of Mortality) score and PIM (Pediatric Index of Mortality) score in a tertiary care pediatric ICU. Indian J Pediatr 2010; 77 (03) 267-271
• 5 Shukla VV, Nimbalkar SM, Phatak AG, Ganjiwale JD. Critical analysis of PIM2 score applicability in a tertiary care PICU in WESTERN India. Int J Pediatr 2014; 2014: 703942
• 6 Kadam SR, Karambelkar GR. The relevance of 24 hour PRISM III score in predicting mortality in pediatric intensive care unit. Int J Pharm 2013; 3: 214-219
• 7 Raghavendra Bhupal YJ, Patil VD, Bellad RM, Mahanthshetti NS. A prospective cohort study for the comparison of two prognostic scores - PRISM 3 and PIM 2 in a pediatric intensive care unit. J Evol Med Dent Sci 2014; 45: 10954-10966
• 8 Sankar J, Chandel A, Dubey NK, Sreenivas V, Sankar MJ. Do interventions in an ICU affect the predictive ability of pediatric index of mortality and pediatric index of mortality-2 scores in a tertiary care hospital?. Pediatr Crit Care Med 2013; 14 (02) e70-e76
• 9 Imamura T, Nakagawa S, Goldman RD, Fujiwara T. Validation of pediatric index of mortality 2 (PIM2) in a single pediatric intensive care unit in Japan. Intensive Care Med 2012; 38 (04) 649-654
• 10 Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143 (01) 29-36
• 11 Lemeshow S, Hosmer Jr DW. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol 1982; 115 (01) 92-106
• 12 Alsuheel AM, Shati A. Factors predicting mortality in pediatric intensive care unit in a tertiary care center southwest region, Saudi Arabia. J Med Med Sci 2014; 5: 113-120
• 13 Thukral A, Lodha R, Irshad M, Arora NK. Performance of Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality (PIM), and PIM2 in a pediatric intensive care unit in a developing country. Pediatr Crit Care Med 2006; 7 (04) 356-361
• 14 Eulmesekian PG, Pérez A, Minces PG, Ferrero H. Validation of pediatric index of mortality 2 (PIM2) in a single pediatric intensive care unit of Argentina. Pediatr Crit Care Med 2007; 8 (01) 54-57
• 15 Gemke RJ, van Vught J. Scoring systems in pediatric intensive care: PRISM III versus PIM. Intensive Care Med 2002; 28 (02) 204-207
• 16 Choi KM, Ng DK, Wong SF. , et al. Assessment of the Pediatric Index of Mortality (PIM) and the Pediatric Risk of Mortality (PRISM) III score for prediction of mortality in a paediatric intensive care unit in Hong Kong. Hong Kong Med J 2005; 11 (02) 97-103
• 17 Ciofi degli Atti ML, Cuttini M, Ravà L. , et al. Performance of the pediatric index of mortality 2 (PIM-2) in cardiac and mixed intensive care units in a tertiary children's referral hospital in Italy. BMC Pediatr 2013; 13: 100
• 18 Bilan N, Galehgolab BA, Emadaddin A, Shiva Sh. Risk of mortality in pediatric intensive care unit, assessed by PRISM-III. Pak J Biol Sci 2009; 12 (06) 480-485
• 19 Khilnani P, Sarma D, Singh R. , et al. Demographic profile and outcome analysis of a tertiary level pediatric intensive care unit. Indian J Pediatr 2004; 71 (07) 587-591
• 20 Labib Youssef MR, Mosleh H, Rene Labib J. Assessment of the performance of the Pediatric Index of Mortality 2 (PIM2) among Egyptian pediatric patients admitted to the intensive care. Egypt Pediatr Assoc Gaz 2014; 62: 65-71
• 21 Hariharan S, Krishnamurthy K, Grannum D. Validation of Pediatric Index of Mortality-2 scoring system in a pediatric intensive care unit, Barbados. J Trop Pediatr 2011; 57 (01) 9-13
• 22 Wolfler A, Silvani P, Musicco M, Salvo I. ; Italian Pediatric Sepsis Study (SISPe) Group. Pediatric Index of Mortality 2 score in Italy: a multicenter, prospective, observational study. Intensive Care Med 2007; 33 (08) 1407-1413
• 23 Poddar B, Naranje K, Gurjar M, Singh RK, Azim A, Baronia AK. Performance of PIM 2 and PIM 3 scores in a single, tertiary care combined Indian ICU. Pediatr Crit Care Med 2014; 15: 156