Overall and subgroup specific performance of the pediatric index of mortality 2 score in Switzerland: a national multice
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ORIGINAL ARTICLE
Overall and subgroup specific performance of the pediatric index of mortality 2 score in Switzerland: a national multicenter study Angelo Polito 1 & Caroline Giacobino 2 & Christophe Combescure 2 & Yann Levy-Jamet 1 & Peter Rimensberger 1 & Swiss Society of Intensive Care Medicine Received: 21 October 2019 / Revised: 19 February 2020 / Accepted: 18 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Pediatric Index of Mortality (PIM) 2 score is used in pediatric intensive care unit (PICU) to predict the patients’ risk of death. The performance of this model has never been assessed in Switzerland. The aim of this study was to evaluate the performance of the PIM2 score in the whole cohort and in pre-specified diagnostic subgroups of patients admitted to PICUs in Switzerland. All children younger than 16 years admitted to any PICU in Switzerland between January 1, 2012 and December 31, 2017 were included in the study. A total of 22,382 patients were analyzed. Observed mortality was 2%, whereas mortality predicted by PIM2 was 4.2% (SMR = 0.47, 95% CI, 0.42–0.52). Calibration was also poor across the deciles of mortality risks (p < 0.001). The AUC-ROC for the entire cohort was 0.88 (95% CI, 0.87–0.90). Calibration varied significantly according to primary diagnosis. Conclusion: The performance of the PIM 2 score in a cohort of Swiss patients is poor with adequate discrimination and poor calibration. The PIM 2 score tends to under predict the number of deaths among septic patients and in patients admitted after a cardiorespiratory arrest. What is Known: •PIM2 score is a widely used mortality prediction model in PICU. •PIM2 performance among uncommon but clinically relevant diagnostic subgroups of patients is unknown. •The performance of PIM2 score has never been assessed in Switzerland. What is New: •The performance of the PIM 2 score in a cohort of Swiss patients is poor with adequate discrimination and poor calibration. •Calibration varies significantly according to primary diagnosis. The PIM 2 score under predict the number of deaths among septic patients and in patients admitted after a cardiorespiratory arrest.
Keywords Children . Risk of mortality . Outcome/quality measure . Pediatric intensive care unit . Standardized mortality ratio . Validation studies Abbreviations AUC ROC receiver operating characteristics curve HL Hosmer-Lemeshow MDSi minimal intensive care unit dataset
PICU PIM SMR
pediatric intensive care unit pediatric index of mortality standardized mortality ratio
Communicated by Piet Leroy * Angelo Polito [email protected] Caroline Giacobino [email protected] Christophe Combescure [email protected] Yann Levy-Jamet [email protected]
Peter Rimensberger [email protected] 1
Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital of Geneva, 6 rue Willy Donzé, CH-1211 Geneva, Switzerland
2
Division of Clinical Epidemiology, Faculty of Medicine, University of Geneva, and Geneva
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