Slater Anthony, Shann Frank
Paediatric Intensive Care Unit, Women's and Children's Hospital, The University of Adelaide, Adelaide, Australia.
Pediatr Crit Care Med. 2004 Sep;5(5):447-54. doi: 10.1097/01.PCC.0000138557.31831.65.
To compare the performance of the Pediatric Index of Mortality (PIM), PIM2, the Pediatric Risk of Mortality (PRISM), and PRISM III in Australia and New Zealand.
A two-phase prospective observational study. Phase 1 assessed the performance of PIM, PRISM, and PRISM III between 1997 and 1999. Phase 2 assessed PIM2 in 2000 and 2001.
Ten intensive care units in Australia and New Zealand.
Included in the study were 26,966 patients aged <16 yrs; 1,147 patients died in the intensive care unit.
None.
Discrimination between death and survival was assessed by calculating the area under the receiver operating characteristic plot for each model. The areas (95% confidence interval) for PIM, PIM2, PRISM, and PRISM III were 0.89 (0.88-0.90), 0.90 (0.88-0.91), 0.90 (0.89-0.91), and 0.93 (0.92-0.94). The calibration of the models was assessed by comparing the number of observed to predicted deaths in different diagnostic and risk groups. Prediction was best using PIM2 with no difference between observed and expected mortality (standardized mortality ratio [95% confidence interval] 0.97 [0.86-1.05]). PIM, PRISM III, and PRISM all overpredicted death, predicting 116%, 130%, and 189% of observed deaths, respectively. The performance of individual units was compared during phase 1, using PIM, PRISM, and PRISM III. There was agreement between the models in the identification of outlying units; two units performed better than expected and one unit worse than expected for each model.
Of the models tested, PIM2 was the most accurate and had the best fit in different diagnostic and risk groups; therefore, it is the most suitable mortality prediction model to use for monitoring the quality of pediatric intensive care in Australia and New Zealand. More information about the performance of the models in other regions is required before these results can be generalized.
比较儿童死亡率指数（PIM）、PIM2、儿童死亡风险指数（PRISM）及PRISM III在澳大利亚和新西兰的性能表现。
一项分两阶段的前瞻性观察性研究。第一阶段评估1997年至1999年间PIM、PRISM及PRISM III的性能表现。第二阶段在2000年和2001年评估PIM2。
澳大利亚和新西兰的10个重症监护病房。
纳入研究的为26966名年龄小于16岁的患者；1147名患者在重症监护病房死亡。
无。
通过计算每个模型的受试者操作特征曲线下面积评估死亡与存活之间的区分度。PIM、PIM2、PRISM及PRISM III的曲线下面积（95%置信区间）分别为0.89（0.88 - 0.90）、0.90（0.88 - 0.91）、0.90（0.89 - 0.91）和0.93（0.92 - 0.94）。通过比较不同诊断和风险组中观察到的死亡数与预测死亡数评估模型的校准情况。使用PIM2进行预测效果最佳，观察到的死亡率与预期死亡率之间无差异（标准化死亡率[95%置信区间]0.97[0.86 - 1.05]）。PIM、PRISM III和PRISM均高估了死亡情况，分别预测了观察到死亡数的116%、130%和189%。在第一阶段，使用PIM、PRISM和PRISM III比较了各个单位的性能表现。各模型在识别异常单位方面具有一致性；每个模型都有两个单位表现优于预期，一个单位表现差于预期。
在所测试的模型中，PIM2最为准确，且在不同诊断和风险组中拟合度最佳；因此，它是澳大利亚和新西兰用于监测儿科重症监护质量的最合适的死亡率预测模型。在这些结果能够推广之前，还需要更多关于这些模型在其他地区性能表现的信息。
