Validation of the Pediatric Index of Mortality 3 in a Single Pediatric Intensive Care Unit in Korea.
10.3346/jkms.2017.32.2.365
- Author:
Ok Jeong LEE
1
;
Minyoung JUNG
;
Minji KIM
;
Hae Kyoung YANG
;
Joongbum CHO
Author Information
1. Department of Pediatrics, Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea.
- Publication Type:Original Article
- Keywords:
Mortality;
Critical Care;
Risk Adjustment;
Child;
Validation Study;
Benchmarking
- MeSH:
Adult;
Benchmarking;
Calibration;
Child;
Cohort Studies;
Critical Care*;
Discrimination (Psychology);
Humans;
Intensive Care Units*;
Korea*;
Mortality*;
Retrospective Studies;
Risk Adjustment
- From:Journal of Korean Medical Science
2017;32(2):365-370
- CountryRepublic of Korea
- Language:English
-
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.
