All issues > Volume 51(11); 2008

Original Article

Korean J Pediatr. 2008;51(11):1158-1164. Published online November 15, 2008.

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

Hui Seung HS Hwang¹, Na Young NY Lee¹, Seung Beom SB Han¹, Ga Young GY Kwak¹, Soo Young SY Lee¹, Seung Yun SY Chung¹, Jin Han JH Kang¹, Dae Chul DC Jeong¹

¹Department of Pediatrics, College of Medicine, The Catholic University of Korea

Correspondence Dae Chul DC Jeong ,Email: dcjeong@catholic.ac.kr

Abstract

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 2003 to December 2007. 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 193 medical records but analyzed 190 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 0.858 (95% confidence interval; 0.779-0.938) for PIM2, 0.798 (95% CI; 0.686-0.891) for PRISM III, respectively. Further, SMR was calculated approximately as 1 for the 2 systems, and multiple logistic regression analysis showed χ2 (13)=14.986, P=0.308 for PIM2, χ2 (13)= 12.899, P=0.456 for PRISM III in Hosmer-Lemeshow goodness-of-fit. However, PIM2 was significant for PRISM III in the likelihood ratio test (χ2 (4)=55.3, P<0.01).
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.

Keywords :Mortality, Pediatric, Intensive care unit