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KMID : 1130320080510111158
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Korean Journal of Pediatrics
2008 Volume.51 No. 11 p.1158 ~ p.1164
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Performance effectiveness of pediatric index of mortality 2 (PIM2) and pediatricrisk of mortality III (PRISM III) in pediatric patients with intensive care in single institution: Retrospective study
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Hwang Hui-Sung
Lee Na-Young
Han Seung-Beom
Kwak Ga-Young
Lee Soo-Young
Chung Seung-Yun
Kang Jin-Han
Jeong Chang-Mo
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Abstract
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Purpose: To investigate the discriminative ability of pediatric index of mortality 2 (PIM2 ) and pediatric risk of mortality III (PRISM III) in predicting mortality in children admitted into the intensive care unit (ICU).
Methods: We retrospectively analyzed variables of PIM2 and PRISM III based on medical records with children cared for in a single hospital ICU from January 2 0 0 3 to December 2 0 0 7 . Exclusions were children who died within 2 h of admission into ICU or hopeless discharge. We used Students t test and ANOVA for general characteristics and for correlation between survivors and non-survivors for variables of PIM2 and PRISM III. In addition, we performed multiple logistic regression analysis for Hosmer-Lemeshow goodness-of-fit, receiver operating characteristic curve (ROC) for discrimination, and calculated standardized mortality ratio (SMR) for estimation of prediction.
Results: We collected 1 9 3 medical records but analyzed 1 9 0 events because three children died within 2 h of ICU admission. The variables of PIM2 correlated with survival, except for the presence of post-procedure and low risk. In PRISM III, there was a significant correlation for cardiovascular/neurologic signs, arterial blood gas analysis but not for biochemical and hematologic data. Discriminatory performance by ROC showed an area under the curve 0 .8 5 8 (9 5 % confidence interval; 0 .7 7 9 -0 .9 3 8 ) for PIM2 , 0 .7 9 8 (9 5 % CI; 0 .6 8 6 -0 .8 9 1 ) for PRISM III, respectively. Further, SMR was calculated approximately as 1 for the 2 systems, and multiple logistic regression analysis showed χ2 (1 3 )=1 4 .9 8 6 , P=0 .3 0 8 for PIM2 , χ2 (1 3 )=1 2 .8 9 9 , P=0 .4 5 6 for PRISM III in Hosmer-Lemeshow goodness-of-fit. However, PIM2 was significant for PRISM III in the likelihood ratio test (χ2 (4 )=5 5 .3 , P< 0 .0 1 ).
Conclusion: We identified two acceptable scoring systems (PRISM III, PIM2 ) for the prediction of mortality in children admitted into the ICU. PIM2 was more accurate and had a better fit than PRISM III on the model tested.
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KEYWORD
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Mortality, Pediatric, Intensive care unit
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