Abstract
IntroductionOutcome of patients admitted to PICU can be evaluated by many illness severity scoring systems. This prospective observational study evaluated the outcome of patients admitted to PICU in Fayoum University hospital of a developing country using the pediatric index of mortality version 2 scoring system.MethodsAll patients included in this study were subjected to data collection including demographics, diagnoses at admission, duration of ICU stay (DOS), pediatric index of mortality version 2 (PIM2) score and hospital outcome. The ratio of observed to predicted mortality (standardized mortality ratio (SMR)) was calculated for the set of patients.ResultsThe study included 205 patients. The main causes of admission were respiratory, cardiovascular and neurological illnesses. Patients stay in ICU ranged from 1 - 45 days with a median 6 (interquartile range (IQ): 3-9) days. Discriminatory function of PIM2 scoring system was acceptable with the area under the ROC curve 0.76 (95%CI: 0.60-0.91). PIM2 calibrated well using Hosmer Lemeshow analysis (H-L X2= 1.410, df= 8, p=0.9). The mean predicted mortality was 5.6 (95% CI: 3.43 - 7.91) and the observed mortality was 8.8% giving a SMR 1.55.ConclusionPIM2 scoring system show adequate discriminatory function and well calibrated for the case mix of patients in PICU of Fayoum, Egypt. It can be used as beneficial tool for evaluation of risk adjusted mortality. Further larger scale studies in cooperation with other Egyptian universities and neighboring countries can improve the performance of our PICUs and critical care services.
Highlights
Outcome of patients admitted to pediatric intensive care unit (PICU) can be evaluated by many illness severity scoring systems
The predicted mortality by pediatric index of mortality version 2 (PIM2) score ranged from 0.03% - 96.5% with a mean 5.67%
Calibration of PIM2 using Hosmer Lemeshow goodness-offit-chi square test showed a good calibration of the model to studied patients in our PICU (H-L X2= 1.410, p=0.9)
Summary
Outcome of patients admitted to PICU can be evaluated by many illness severity scoring systems. Scoring systems are used to predict the outcome of patients admitted to intensive care units [2] They are used to evaluate the performance of ICUs [3]. Because of the large differences in case mix, comparing the mortality among different units and countries must be corrected for the severity of illness on admission to the ICU and severity scoring systems have proved valuable for quality assurance and research in intensive care medicine [5]. Pediatric index of mortality version 2 (PIM2) scoring system was validated in different regions including developed and developing countries, reports about its application in our region are lacking The objective of this prospective study was to determine the performance of PIM2 score in Fayoum University Hospital pediatric ICU, to assess the quality of critical care services in our unit and to compare it with the international reports
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