Jeyanthi, G (2012) Pediatric Index of Mortality – 2 (PIM-2) Score as Predictor of Mortality In PICU. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Many illness severity scoring systems are being used for predicting the outcome of patients admitted to intensive care units (ICU) (1). Although it is difficult to predict individual outcome of ICU patients accurately, there have been attempts to codify and validate models which may prognosticate groups of patients having similar presentations of the illness (2). Scoring systems are primarily being used to predict the general prognosis of patients but are also used as performance indicators of ICUs (3). Pediatric Index of Mortality (PIM) was introduced by Shann et al in 1997 to predict outcome in children admitted to ICUs (4). This system was revised (PIM-2) and published in the year 2003 and is supposedly better than the earlier version in outcome- predictability(5) Scoring systems and their need: There is an increase in emphasis on the evaluation and monitoring of various aspects of health care services. Scoring systems aim at providing an objective and measurable value for any such service. The goal is to provide the highest quality of care with available resources to achieve best outcome. All scoring systems are designed to quantify and reduce a number of discrete but interrelated patient characteristics to a single value. This value can be used to compare and analyze disease severity, therapies used or final outcome. The scoring system forms the backbone of any hospital audit. AIM OF THE STUDY: 1.PRIMARY: To evaluate the usefulness of PIM 2 score in predicting mortality in PICU in a tertiary care pediatric hospital. 2. SECONDARY: To assess the associated factors predicting mortality such as need for assisted ventilation, presence of shock and poor Glasgow coma scale. DISCUSSION: The use of scoring systems and the audit of intensive care has not been widely reported in India. There have been few studies addressing the needs of pediatric critical care. Most scoring systems were designed in the west and need to be validated in our country. In our study, the discrimination of PIM 2 score between death and survival was good at cutoff 99.8, reflected by area under Receiver operating characteristic curve(ROC) which was 0.843 (95% C.I: 0.765, 0.903). Hariharan S, et al showed that PIM2 score had good discrimination, with area under ROC being 0.82 (95% C.I: 0.72-0.92) in a PICU of a developing country (12). Clearly PIM2 score performed well in our study and it is comparable to the original developer of PIM2 score, Slater A, who showed, PIM2 discriminated between death and survival well, with area under the receiver operating characteristic (ROC) plot 0.90 (0.89-0.92).(5) Since the sensitivity of PIM 2 score, at significant PIM2 (log it) score criterion >99.8 was 98.18%, it can be used as a screening tool for assessing severity of illness of PICU admissions. Since the PIM2 (logit) score has high negative predictive value (97.7%) at cut off of PIM2 (logit) score of 99.8, there were more chances for the child to survive, if he/she scores less than 99.8.This helps to identify children who have more chances of survival which helps in counseling parents and get their co-operation. The low specificity (65.6%) of PIM2 (logit) score denotes not all patients with high score are going for mortality. This reflects effective interventions at PICU, reduces mortality of those who had high score at the time of admission and thereby indicating good performance of PICU. CONCLUSION: 1. PIM 2 score discriminated well between survivors and death at PICU of this tertiary pediatric care hospital. 2. PIM 2 score provides an objective assessment of severity of illness. 3. PIM 2 score helps to assess the severity of illness earlier (within an hour). Based on this, early vigorous management can be done in clinically borderline severe cases, which would have been missed otherwise and patients can be saved. 4. Associated factors such as presence of shock, need for mechanical ventilation were significantly associated with mortality.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Pediatric Index ; Mortality – 2 (PIM-2) Score ; Predictor ; Mortality ; PICU |
| Subjects: | MEDICAL > Paediatrics |
| Depositing User: | Ravindran C |
| Date Deposited: | 13 Apr 2018 11:48 |
| Last Modified: | 13 Apr 2018 11:48 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6998 |
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