Validación del índice pediátrico de mortalidad 2 (PIM2) en Argentina: un estudio prospectivo, multicéntrico, observacional

Fernández, Ariel L.; López, María P Arias; Ratto, María E.; Saligari, Liliana; Serrate, Alejandro Siaba; Rosa, Marcela de la; Raúl, Norma; Boada, Nancy; Gallardo, Paola Fabiana; Ko, Inja; Schnitzler, Eduardo

doi:10.5546/aap.2015.221

Cited by 8 publications

(3 citation statements)

References 25 publications

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“…Notably, more than half our PICU patients did not require mechanical ventilation, even in the unplanned admission group (43%), which is similar to that reported in previous studies, including a large multicenter cohort in Latin America (48-53%%) ( 13 , 20 ) We interpret this as a marker of proactive identification of deterioration events and timely PICU transfer of patients with critical illness. While it may be argued that some of these admissions do not actually experience critical illness, our expected mortality is similar to that of a large Argentinian cohort ( 25 ). Similarly, our observed mortality and performance (observed/expected mortality) in the unplanned admissions, mechanical ventilation and RRT subgroups is comparable to that of high-resource settings.…”

Section: Discussionsupporting

confidence: 54%

Outcomes for critical illness in children with cancer: Analysis of risk factors for adverse outcome and resource utilization from a specialized center in Mexico

et al. 2022

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IntroductionChildren with cancer have a higher risk of adverse outcomes during critical illness than general pediatric populations. In Low- and middle-income countries, lack of resources can further negatively impact outcomes in critically ill children with cancer.MethodsIn this study, we describe the outcomes of a large cohort of children with cancer including mortality and resource utilization. We performed a retrospective review of all patients admitted to our PICU between December 12th, 2013 and December 31st, 2019. Outcomes were defined as recovery or death and resource utilization was described via use of critical care interventions, Length of stay as well as PICU- and Mechanical Ventilation- free days.ResultsOverall mortality was 6.9% while mortality in the unplanned admissions was 9.1%. This remained lower than expected mortality based on PIM2 scoring. Type of PICU admission, Neurological Deterioration as a cause of PICU admission, and PIM2 were significant as risk factors in univariate analysis, but only PIM2 remained significant in the multivariate analysis.DiscussionOur Study shows that high survival rates are achievable for children with cancer with critical illness in resource-limited settings with provision of high-quality critical care. Organizational and clinical practice facilitating quality improvement and early identification and management of critical illness may attenuate the impact of known risk factors for mortality in this population.

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Section: Discussionsupporting

confidence: 54%

Outcomes for critical illness in children with cancer: Analysis of risk factors for adverse outcome and resource utilization from a specialized center in Mexico

et al. 2022

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“…They generally showed good discrimination but poor calibration. In these studies, PIM2 tended to underestimate mortality ( 29 , 31 , 33 , 34 ) but overestimated in one ( 30 ). PIM3 also had good discrimination but poor calibration ( 13 , 14 , 36 , 37 ).…”

Section: Discussionmentioning

confidence: 77%

Multicenter validation of PIM3 and PIM2 in Brazilian pediatric intensive care units

Genu

Lima‐Setta²,

Colleti³

et al. 2022

Front. Pediatr.

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ObjectiveTo validate the PIM3 score in Brazilian PICUs and compare its performance with the PIM2.MethodsObservational, retrospective, multicenter study, including patients younger than 16 years old admitted consecutively from October 2013 to September 2019. We assessed the Standardized Mortality Ratio (SMR), the discrimination capability (using the area under the receiver operating characteristic curve – AUROC), and the calibration. To assess the calibration, we used the calibration belt, which is a curve that represents the correlation of predicted and observed values and their 95% Confidence Interval (CI) through all the risk ranges. We also analyzed the performance of both scores in three periods: 2013–2015, 2015–2017, and 2017–2019.Results41,541 patients from 22 PICUs were included. Most patients aged less than 24 months (58.4%) and were admitted for medical conditions (88.6%) (respiratory conditions = 53.8%). Invasive mechanical ventilation was used in 5.8%. The median PICU length of stay was three days (IQR, 2–5), and the observed mortality was 1.8% (763 deaths). The predicted mortality by PIM3 was 1.8% (SMR 1.00; 95% CI 0.94–1.08) and by PIM2 was 2.1% (SMR 0.90; 95% CI 0.83–0.96). Both scores had good discrimination (PIM3 AUROC = 0.88 and PIM2 AUROC = 0.89). In calibration analysis, both scores overestimated mortality in the 0%–3% risk range, PIM3 tended to underestimate mortality in medium-risk patients (9%–46% risk range), and PIM2 also overestimated mortality in high-risk patients (70%–100% mortality risk).ConclusionsBoth scores had a good discrimination ability but poor calibration in different ranges, which deteriorated over time in the population studied.

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“…The Pediatric Index of Mortality 2 (PIM2) is a widely used prognostic score that has been properly validated in the pediatric population. 3 , 4 By means of ten clinical and laboratory variables, PIM2 provides a percentage result that indicates the probability of death. Other laboratory tests that are not part of the PIM2 formula have also been studied as prognostic biomarkers, whether alone or in combination.…”

Section: Introductionmentioning

confidence: 99%

Performance of prognostic markers in pediatric sepsis

Tonial

Costa

Andrades

et al. 2021

Jornal de Pediatria

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Validación del índice pediátrico de mortalidad 2 (PIM2) en Argentina: un estudio prospectivo, multicéntrico, observacional

Cited by 8 publications

References 25 publications

Outcomes for critical illness in children with cancer: Analysis of risk factors for adverse outcome and resource utilization from a specialized center in Mexico

Outcomes for critical illness in children with cancer: Analysis of risk factors for adverse outcome and resource utilization from a specialized center in Mexico

Multicenter validation of PIM3 and PIM2 in Brazilian pediatric intensive care units

Performance of prognostic markers in pediatric sepsis

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