Overall and subgroup specific performance of the pediatric index of mortality 2 score in Switzerland: a national multicenter study

• Published in: European journal of pediatrics Vol. 179; no. 10; pp. 1515 - 1521
• Main Authors: Polito, Angelo, Giacobino, Caroline, Combescure, Christophe, Levy-Jamet, Yann, Rimensberger, Peter
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2020; Springer Nature B.V
• Subjects: Adolescent; Calibration; Child; Child Mortality; Child, Preschool; Diagnosis; Hospital Mortality; Humans; Infant; Infant, Newborn; Intensive Care Units, Pediatric; Medicine; Medicine & Public Health; Mortality; Original Article; Pediatrics; Prediction models; Prospective Studies; ROC Curve; Switzerland - epidemiology; Switzerland; Risk of mortality; Outcome/quality measure; Children; Pediatric intensive care unit; Standardized mortality ratio; Validation studies
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s00431-020-03639-y

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.