P0561 / #1822: PAEDIATRIC INDEX OF MORTALITY 3 – AN EVALUATION OF FUNCTION AMONG INTENSIVE CARE UNITS IN SOUTH AFRICA.

Abstract

Aims & Objectives: To evaluate the performance of Paediatric Index of Mortality 3 in South Africa. Methods: A prospective observational study of all admissions aged 30 days to 18 years for a period of 12 months to nine tertiary or quartenary academic Hospitals in South Africa. Data gathered: age and gender; diagnosis and reason for PICU admission; data specific for the PIM 3 calculation; PICU death or survival, and length of stay. Results: There were 3681 admissions. 2253 (61.27%) were male. Median age was 18.00 months (Interquartile range: 6; 59.5). 354 (9.62%) died. The standardized mortality ratio (SMR) was 1.28. The area under the receiver operating characteristic curve was 0.81 (95% CI 0.79; 0.83). The Hosmer-Lemeshow goodness of fit test statistic was 175.89 (p <0.001). SMR for age groups was greater than 1. SMR for and diagnostic subgroups was > 1 except for those whose reason for PICU admission was classified as accident, toxin and envenomation, and metabolic whth SMR < 1. There were similar proportions of respiratory and post-operative non-cardiac patients but significantly greater proportions of neurological and cardiac (including post-operative) patients in the PIM 3 derivation cohort than the South African cohort. In contrast, the South African cohort contained a significantly greater proportion of miscellaneous including injury / accident victims and post-operative non-cardiac patients. Conclusions: PIM 3 discrimination between death and survival was acceptable. Calibration was poor. Case mix differences between South African units and the PIM 3 derivation cohort may partly explain the poor calibration. PIM 3 needs to be recalibrated to the local setting.