OBJECTIVE: To determine the concordance of mortality risk classification through the use of the Pediatric Index of Mortality (PIM) 2 and 3. METHODS: Through a retrospective cohort, we evaluated patients admitted to the pediatric intensive care unit between April 2016 and December 2018. We calculated the mortality risk with the PIM 2 and 3. Analyses were carried out to determine the concordance between the risk classification obtained with both scales using unweighted and linearly weighted kappa. RESULTS: A total of 722 subjects were included, and 66.6% had a chronic condition. The overall mortality was 3.7%. The global kappa concordance coefficient for classifying patients according to risk with the PIM 2 and 3 was moderate at 0.48 (95%CI 0.43 - 0.53). After linear weighting, concordance was substantial at 0.64 (95%CI 0.59 - 0.69). For cardiac surgery patients, concordance for risk classification was fair at 0.30 (95%CI 0.21 - 0.39), and after linear weighting, concordance was only moderate at 0.49 (95%CI 0.39 - 0.59). The PIM 3 assigned a lower risk than the PIM 2 in 44.8% of patients in this subgroup. CONCLUSION: Our study proves that the PIM 2 and 3 are not clinically equivalent and should not be used interchangeably for quality evaluation across pediatric intensive care units. Validation studies must be performed before using the PIM 2 or PIM 3 in specific settings.
OBJECTIVE: To determine the concordance of mortality risk classification through the use of the Pediatric Index of Mortality (PIM) 2 and 3. METHODS: Through a retrospective cohort, we evaluated patients admitted to the pediatric intensive care unit between April 2016 and December 2018. We calculated the mortality risk with the PIM 2 and 3. Analyses were carried out to determine the concordance between the risk classification obtained with both scales using unweighted and linearly weighted kappa. RESULTS: A total of 722 subjects were included, and 66.6% had a chronic condition. The overall mortality was 3.7%. The global kappa concordance coefficient for classifying patients according to risk with the PIM 2 and 3 was moderate at 0.48 (95%CI 0.43 - 0.53). After linear weighting, concordance was substantial at 0.64 (95%CI 0.59 - 0.69). For cardiac surgery patients, concordance for risk classification was fair at 0.30 (95%CI 0.21 - 0.39), and after linear weighting, concordance was only moderate at 0.49 (95%CI 0.39 - 0.59). The PIM 3 assigned a lower risk than the PIM 2 in 44.8% of patients in this subgroup. CONCLUSION: Our study proves that the PIM 2 and 3 are not clinically equivalent and should not be used interchangeably for quality evaluation across pediatric intensive care units. Validation studies must be performed before using the PIM 2 or PIM 3 in specific settings.
Authors: F Lacour-Gayet; D Clarke; J Jacobs; J Comas; S Daebritz; W Daenen; W Gaynor; L Hamilton; M Jacobs; B Maruszsewski; M Pozzi; T Spray; G Stellin; C Tchervenkov; C Mavroudis And Journal: Eur J Cardiothorac Surg Date: 2004-06 Impact factor: 4.191
Authors: Idse H E Visser; Jan A Hazelzet; Marcel J I J Albers; Carin W M Verlaat; Karin Hogenbirk; Job B van Woensel; Marc van Heerde; Dick A van Waardenburg; Nicolaas J G Jansen; Ewout W Steyerberg Journal: Intensive Care Med Date: 2013-02-22 Impact factor: 17.440
Authors: Lahn Straney; Archie Clements; Roger C Parslow; Gale Pearson; Frank Shann; Jan Alexander; Anthony Slater Journal: Pediatr Crit Care Med Date: 2013-09 Impact factor: 3.624