Validation of pediatric index of mortality 3 for predicting mortality among pediatric patients admitted to an intensive care unit in Korea

Abstract

Background: For advancement in pediatric critical care medicine, the precise prediction of survival is considered imperative. The pediatric index of mortality (PIM) 3 was developed in 2013; it is a representative and simple model consisting of 10 variables that are measured at the time of admission to intensive care units (ICUs). Objectives: The objectives of this study were to evaluate the usefulness of the PIM 3 for predicting mortality and validating PIM 3 in Korean children admitted to a single intensive care unit. Subjects and Methods: We enrolled children at least 1 month old but less than 18 years of age who were admitted to the Severance Hospital Medical ICU between March 2009 and February 2015. Performances of the pediatric risk of mortality (PRISM) III, PIM 2, and PIM 3 were evaluated by assessing the area under the receiver operating characteristic (ROC) curve, conducting the Hosmer-Lemeshow test, and calculating the standardized mortality ratio (SMR). Results: In total, 503 children were enrolled; the areas under the ROC curve for PRISM III, PIM 2, and PIM 3 were 0.775, 0.796, and 0.826, respectively. The area under the ROC curve was significantly greater for PIM 3 than for PIM 2 (P < 0.001) and PRISM III (P = 0.016). There were no significant differences in the Hosmer-Lemeshow test results for PRISM III (P = 0.498), PIM 2 (P = 0.249), and PIM 3 (P = 0.337). The SMR calculated using PIM 3 (1.11) was closer to 1 than that calculated using PIM 2 (0.84). Conclusion: PIM 3 showed better prediction for the risk of mortality than PIM 2 for the Korean pediatric population admitted in the ICU.