在儿科重症监护病房中使用儿童死亡率指数（PIM）-3和PIM-2模型的结果比较
Comparison of Outcomes using Pediatric Index of Mortality (PIM) -3 and PIM-2 Models in a Pediatric Intensive Care Unit.
作者信息
Sankar Jhuma, Gulla Krishna Mohan, Kumar U Vijaya, Lodha Rakesh, Kabra S K
机构信息
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr Jhuma Sankar, Assistant Professor, Department of Pediatrics, AIIMS, New Delhi, India.
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
出版信息
Indian Pediatr. 2018 Nov 15;55(11):972-974.
OBJECTIVE
To compare patient outcomes using the Pediatric Index of Mortality-3 (PIM-3) model with PIM-2 model for children admitted to the intensive care unit.
METHODS
We prospectively recorded the baseline characteristics, variables of PIM-3 and PIM-2 at admission, and outcomes of children ≤17 years over a period of 11 months. We used Area Under Receiver Operating Characteristics (AU-ROC) curves and Goodness-of-fit (GOF) tests to determine which of the two models had better discrimination and calibration.
RESULTS
Out of 202 children enrolled, 69 (34%) died. Sepsis and pneumonia were the common admitting diagnoses. The AU-ROC was better for PIM-3 (0.75) as compared to PIM-2 (0.69; P=0.001). The GOF-P value was 0.001 for both models, that indicated poor calibration of both (P<0.001). The AU-ROC curves were acceptable across different age and diagnostic sub-groups.
CONCLUSION
PIM-3 had better discrimination when compared to PIM-2 in our unit. Both models had poor calibration across deciles of risk.
目的
比较使用儿童死亡率指数3（PIM - 3）模型和PIM - 2模型对入住重症监护病房的儿童患者的预后情况。
方法
我们前瞻性地记录了11个月期间年龄≤17岁儿童的基线特征、入院时PIM - 3和PIM - 2的变量以及预后情况。我们使用受试者操作特征曲线下面积（AU - ROC）和拟合优度（GOF）检验来确定这两种模型中哪种具有更好的区分度和校准度。
结果
在纳入的202名儿童中，69名（34%）死亡。脓毒症和肺炎是常见的入院诊断。与PIM - 2（0.69；P = 0.001）相比，PIM - 3的AU - ROC更好（0.75）。两种模型的GOF - P值均为0.001，表明两者的校准度都较差（P < 0.001）。AU - ROC曲线在不同年龄和诊断亚组中均可接受。
结论
在我们的单位中，与PIM - 2相比，PIM - 3具有更好的区分度。两种模型在风险十分位数范围内的校准度都较差。
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