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Validation of pediatric index of mortality 2 (PIM2) in a single pediatric intensive care unit in Japan

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Abstract

Objective

The Pediatric Index of Mortality 2 (PIM2), one of the key mortality prediction models for children in intensive care units, has not been validated in Japan. The purpose of this study was to validate the performance of PIM2 in a population of patients admitted to one pediatric intensive care unit (PICU) in Japan.

Methods

This was a prospective cohort study involving consecutive patients admitted to the largest multidisciplinary PICU in Japan between 1 January 2008 and 31 December 2010. There were no interventions.

Results

A total of 2,536 patients were included in this study of whom 67 (2.6%) died. Discrimination between survival and death assessed by the area under the receiver operating characteristic curve was 0.92 [95% confidence interval (CI) 0.89–0.96]. Calibration across the five risk intervals according to the Hosmer–Lemeshow goodness-of-fit test showed a chi-square value of 4.8 (df = 5, p = 0.44). The standardized mortality ratio for the whole population was 0.77 (95% CI 0.59–0.96).

Conclusions

At the largest PICU center in Japan, the PIM2 was found to have excellent discriminatory power and good calibration, although it over-predicted deaths. Based on these results, PIM2 can be used as a good prediction model for pediatric mortality, which is a tool used to assess the overall quality of care in a PICU.

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Acknowledgments

My deepest appreciation goes to Dr. Naoki Shimizu whose support was invaluable during the course of our study. Special thanks to colleagues, fellows and residents for their efforts.

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Authors and Affiliations

  1. Division of Critical Care Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan

    Toshihiro Imamura & Satoshi Nakagawa

  2. Department of Social Medicine, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan

    Toshihiro Imamura & Takeo Fujiwara

  3. The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, BC Children’s Hospital, Child and Family Research Institute, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3N1, Canada

    Ran D. Goldman

Authors
  1. Toshihiro Imamura
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  2. Satoshi Nakagawa
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  3. Ran D. Goldman
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  4. Takeo Fujiwara
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Correspondence to Toshihiro Imamura.

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Imamura, T., Nakagawa, S., Goldman, R.D. et al. Validation of pediatric index of mortality 2 (PIM2) in a single pediatric intensive care unit in Japan. Intensive Care Med 38, 649–654 (2012). https://doi.org/10.1007/s00134-011-2460-5

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  • DOI: https://doi.org/10.1007/s00134-011-2460-5

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