Toteja Nisha, Choudhary Bharat, Khera Daisy, Sasidharan Rohit, Sharma Prem Prakash, Singh Kuldeep
Department of Pediatrics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India.
Department of Trauma and Emergency (Pediatrics), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
J Pediatr Intensive Care. 2021 Dec 23;13(3):235-241. doi: 10.1055/s-0041-1740588. eCollection 2024 Sep.
Pediatric index of mortality-3 (PIM-3) is the latest update of one of the commonly used scoring systems in pediatric intensive care. It has free accessibility and is easy to use. However, there are some skepticisms regarding its practical usefulness in resource-limited settings. Hence, there is a need to generate region-specific data to evaluate its performance in different case mixes and resource constraints. The aim of the study is to evaluate the performance of the PIM-3 score in predicting mortality in a tertiary care PICU of a developing country. This is a retrospective cohort study. All children aged 1 month to 18 years admitted to the PICU during the study period from July 2016 to December 2018 were included. We reviewed the patient admission details and the case records of the enrolled. patients. Patient demographics, disease profile, co-morbidities, and PIM-3 scores were recorded along with the outcome. Area under receiver operating characteristics (AUROC) curves was used to determine discrimination. Standardized mortality ratio (SMR) and Hosmer Lemeshow goodness of fit were used to assess the calibration. Out of 282 children enrolled, 62 (21.9%) died. 58.5% of the patients were males, and 60% were less than 5 years of age. The principal diagnoses included respiratory and neurological conditions. The AUROC for PIM-3 was 0.961 (95% CI [0.93, 0.98]) and overall SMR was 1.28 (95% CI [0.96, 1.59]). Hosmer-Lemeshow goodness-of-fit was suggestive of poor calibration ( = 11.7, < 0.05). We concluded that PIM-3 had good discrimination but poor calibration in our PICU setting.
儿童死亡率指数-3（PIM-3）是儿科重症监护中常用评分系统的最新版本。它可免费获取且易于使用。然而，对于其在资源有限环境中的实际效用存在一些质疑。因此，有必要生成特定区域的数据，以评估其在不同病例组合和资源限制情况下的表现。本研究的目的是评估PIM-3评分在一个发展中国家三级护理儿科重症监护病房（PICU）中预测死亡率的性能。这是一项回顾性队列研究。纳入了2016年7月至2018年12月研究期间入住该PICU的所有1个月至18岁儿童。我们审查了患者的入院详细信息和已登记患者的病例记录。记录了患者的人口统计学信息、疾病概况、合并症以及PIM-3评分和结局。采用受试者工作特征曲线下面积（AUROC）来确定区分度。使用标准化死亡率比（SMR）和Hosmer Lemeshow拟合优度来评估校准情况。在纳入的282名儿童中，62名（21.9%）死亡。58.5%的患者为男性，60%的患者年龄小于5岁。主要诊断包括呼吸系统和神经系统疾病。PIM-3的AUROC为0.961（95%可信区间[0.93, 0.98]），总体SMR为1.28（95%可信区间[0.96, 1.59]）。Hosmer-Lemeshow拟合优度提示校准不佳（χ² = 11.7，P < 0.05）。我们得出结论，在我们的PICU环境中，PIM-3具有良好的区分度，但校准不佳。
