title: Validation of the Pediatric Index of Mortality 3 in a Single Pediatric Intensive Care Unit in Korea.
abstract: To compare mortality rate, the adjustment of case-mix variables is needed. The Pediatric Index of Mortality (PIM) 3 score is a widely used case-mix adjustment system of a pediatric intensive care unit (ICU), but there has been no validation study of it in Korea. We aim to validate the PIM3 in a Korean pediatric ICU, and extend the validation of the score from those aged 0-16 to 0-18 years, as patients aged 16-18 years are admitted to pediatric ICU in Korea. A retrospective cohort study of 1,710 patients was conducted in a tertiary pediatric ICU. To validate the score, the discriminatory power was assessed by calculating the area under the receiver-operating characteristic (ROC) curve, and calibration was evaluated by the Hosmer-Lemeshow goodness-of-fit (GOF) test. The observed mortality rate was 8.47%, and the predicted mortality rate was 6.57%. For patients aged < 18 years, the discrimination was acceptable (c-index = 0.76) and the calibration was good, with a χ² of 9.4 in the GOF test (P = 0.313). The observed mortality rate in the hemato-oncological subgroup was high (18.73%), as compared to the predicted mortality rate (7.13%), and the discrimination was unacceptable (c-index = 0.66). In conclusion, the PIM3 performed well in a Korean pediatric ICU. However, the application of the PIM3 to a hemato-oncological subgroup needs to be cautioned. Further studies on the performance of PIM3 in pediatric patients in adult ICUs and pediatric ICUs of primary and secondary hospitals are needed.
authors.affiliation: Department of Pediatrics, Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea.
authors.forename: Ok Jeong
authors.identifier: http://orcid.org/0000-0001-9234-1424
authors.initials: OJ
authors.lastname: Lee
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Minyoung
authors.identifier: http://orcid.org/0000-0003-2851-9480
authors.initials: M
authors.lastname: Jung
authors.affiliation: Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Minji
authors.identifier: http://orcid.org/0000-0001-5588-5414
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hae Kyoung
authors.identifier: http://orcid.org/0000-0002-8552-0528
authors.initials: HK
authors.lastname: Yang
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. joongbum.cho@gmail.com.
authors.forename: Joongbum
authors.identifier: http://orcid.org/0000-0001-5931-7553
authors.initials: J
authors.lastname: Cho
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D012372:ROC Curve; D056910:Republic of Korea; D012189:Retrospective Studies
keywords: Benchmarking; Child; Critical Care; Mortality; Risk Adjustment; Validation Study