The pediatric index of mortality 3 score to predict mortality in a pediatric intensive care unit in Palembang, South Sumatera, Indonesia
Abstract: For critically ill
patients in the pediatric intensive care unit (PICU), a scoring system is
helpful for assessing the severity of morbidity and predicting the risk of
mortality. The Pediatric Index of Mortality (PIM) 3 score consists of ten easy
simple variables, so that the probability of death can be assessed prior to
undergoing advanced therapies. The PIM 3 score in inexpensive and comprised of
routine laboratory variables performed in PICU patients. In Indonesia, studies
to validate the PIM 3 score have been limited.
Objective To evaluate the PIM 3 score for predicting the probability of
death in the PICU, Dr. Mohammad Hoesin Hospital (MHH), Palembang.
Methods A prospective, cohort study was performed in the PICU, MHH,
Palembang, from February to April 2016. The PIM 3 score was calculated within 2
hours of patients admission to the PICU by an
android calculator application. PIM3 score and mortality were analyzed
by Mann-Whitney test; calibration was performed by Hosmer-Lameshow goodness of
fit test, discrimination was done by receiver operating characteristic (ROC)
curve analysis; and standardized mortality ratio (SMR) was calculated.
Results During the study period there were 81 PICU patients, 69 children
were included, ranging in age from 1,5 to 187 months. The overall mortality
rate was 40,58%. The most common illnesses in our subjects were malignancy
(17,4%), post non-thoracic surgery (14,5%), dengue shock syndrome (14,5%),
respiratory disease (13%), and neurological disease (11,6%). Subjects’ PIM3
scores ranged from 1,02% to 58,84%, with means of 26,08% in non-survivors and
13,05% in survivors. The SMR was 2,24, indicating that death was
underpredicted. The AUC of 0,771 (95% CI of 0,651 to 0,891) indicated that the
PIM3 score had good discrimination.
Conclusion In Mohammad Hoesin Hospital, Palembang, South Sumatera, the
PIM 3 can be used to predict mortality in PICU patients, but the score should
be multiplied by a factor of 2.24. This recalibration is needed due to the
presumed lower standard of care at this hospital compared to that of the
originating PIM 3 institutions in developed countries.
Keywords: PIM3 score;
probability of mortality; PICU MHH Palembang
Author: Destiana Sera Puspita
Sari, Indra Saputra, Silvia Triratna, Mgs. Irsan Saleh
Journal Code: jpkedokterangg170166
