Pediatric Index of Mortality 2 as a predictor of death risk in children admitted to pediatric intensive care units in Latin America: A prospective, multicenter study.
OBJECTIVE
The purpose of this study is to asses the performance of the Pediatric Index of Mortality 2 (PIM2) score in pediatric intensive care units (PICUs) in Latin America.


METHODS
This is a prospective, observational, multicenter study. We included patients aged 1 month to 16 years old admitted consecutively during 1 year to 34 PICUs in 9 Latin American countries. Discrimination and calibration tests were performed to validate the performance of PIM2 in the entire sample and in different subgroups.


RESULTS
A total of 7391 patients were analyzed. Pediatric Index of Mortality 2 predicted 573 deaths, whereas the observed deaths were 663 (P < .001). The area under the receiver operating characteristic curve for the entire population was 0.817 (95% confidence interval, 0.808-0.825). The score showed good discrimination. Instead, calibration was inadequate. The difference between observed and predicted deaths for the entire population and across different risk intervals was statistically significant (χ(2) = 121.87; df = 8; P < .001). Pediatric Index of Mortality 2 did not predict mortality correctly in different diagnostic categories (injury, postoperative, and miscellaneous), in children younger than 12 months, adolescents, and patients with chronic complex conditions.


CONCLUSIONS
Pediatric Index of Mortality 2 showed good discrimination, but calibration was inadequate. To use PIM2 for monitoring PICU performance in Latin America, it might be necessary to recalibrate the score locally.
Hospital de Niños Dr Ricardo Gutiérrez, CABA, Buenos Aires, Argentina. Electronic address: mpariaslopez@gmail.com.
Maria Pilar
MP
Arias Lopez
FUNDASAMIN (Fundación para la Salud Materno Infantil), CABA, Buenos Aires, Argentina.
Ariel L
AL
Fernández
Hospital de Niños Sor María Ludovica de La Plata, La Plata, Buenos Aires, Argentina.
María E
ME
Ratto
Hospital Nacional Profesor Alejandro Posadas, Palomar, Buenos Aires, Argentina.
Liliana
L
Saligari
Hospital Universitario Austral, Pilar, Buenos Aires, Argentina.
Alejandro Siaba
AS
Serrate
Hospital de Niños Dr Ricardo Gutiérrez, CABA, Buenos Aires, Argentina.
In Ja
IJ
Ko
Hospital Israelita Albert Einstein, Morumbi, São Paulo, Brazil.
Eduardo
E
Troster
Hospital Universitario Austral, Pilar, Buenos Aires, Argentina.
Eduardo
E
Schnitzler
D000293:Adolescent; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007843:Latin America / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment
Benchmarking; Mortality; Outcome assessment (health care); Pediatric intensive care unit; Pediatrics; Risk assessment