The suitability of the Pediatric Index of Mortality (PIM), PIM2, the Pediatric Risk of Mortality (PRISM), and PRISM III for monitoring the quality of pediatric intensive care in Australia and New Zealand

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
Anthony SlaterANZICS Paediatric Study Group

Abstract

To compare the performance of the Pediatric Index of Mortality (PIM), PIM2, the Pediatric Risk of Mortality (PRISM), and PRISM III in Australia and New Zealand. A two-phase prospective observational study. Phase 1 assessed the performance of PIM, PRISM, and PRISM III between 1997 and 1999. Phase 2 assessed PIM2 in 2000 and 2001. Ten intensive care units in Australia and New Zealand. Included in the study were 26,966 patients aged <16 yrs; 1,147 patients died in the intensive care unit. None. Discrimination between death and survival was assessed by calculating the area under the receiver operating characteristic plot for each model. The areas (95% confidence interval) for PIM, PIM2, PRISM, and PRISM III were 0.89 (0.88-0.90), 0.90 (0.88-0.91), 0.90 (0.89-0.91), and 0.93 (0.92-0.94). The calibration of the models was assessed by comparing the number of observed to predicted deaths in different diagnostic and risk groups. Prediction was best using PIM2 with no difference between observed and expected mortality (standardized mortality ratio [95% confidence interval] 0.97 [0.86-1.05]). PIM, PRISM III, and PRISM all overpredicted death, predicting 116%, 130%, and 189% of observed deaths, respectively. The performance of individual u...Continue Reading

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