Document Detail


Do interventions in an ICU affect the predictive ability of pediatric index of mortality and pediatric index of mortality-2 scores in a tertiary care hospital?
MedLine Citation:
PMID:  23287905     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Our objective was to evaluate the effect of interventions in the initial period of stabilization (i.e., at 4 hrs) on the predictive ability of Pediatric Index of Mortality and Pediatric Index of Mortality-2 scores and to evaluate their performance in our ICU.
DESIGN: Prospective observational study.
SETTING: PICU of a tertiary care teaching hospital.
PATIENTS: Consecutive children aged 2 months to 17 yr admitted to our ICU from June 2010 to July 2011 were included.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: We prospectively recorded the baseline characteristics, variables of Pediatric Index of Mortality and Pediatric Index of Mortality-2 at 1 and 4 hrs after admission, and the outcome data in a predesigned proforma. We compared the performance of the scores at these two time points by calculating their discriminative ability and calibration as measured by the area under curve of the receiver operating characteristic curves and the Hosmer-Lemeshow goodness-of-fit test, respectively.Of the 282 children enrolled, 93 (32.9%) died. The median (interquartile) age of the study patients was 3.5 yr (0.8, 10). The major reasons for ICU admission as well as mortality were sepsis/severe sepsis and cardiac and neurological illnesses. The area under curves for Pediatric Index of Mortality at 4 and 1 hrs were 0.73 (95% confidence interval 0.66-0.79) and 0.70 (0.63-0.77), respectively. The corresponding values for Pediatric Index of Mortality-2 were 0.72 (0.66-0.79) and 0.71 (0.64-0.78), respectively. The goodness-of-fit test showed a good calibration across deciles of risk for the two scores at both the time points (p > 0.1 for all). The calibration across different age and diagnostic subgroups was also good.
CONCLUSION: Interventions in the first 4 hrs did not affect the predictive ability of Pediatric Index of Mortality and Pediatric Index of Mortality-2 scores. The 4-hr scores may be used in place of the 1-hr score, particularly in units where scoring is not possible with in the 1-hr time frame.
Authors:
Jhuma Sankar; Arnav Chandel; Nand Kishore Dubey; Vishnubhatla Sreenivas; Mari Jeeva Sankar
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  14     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-07     Completed Date:  2013-09-16     Revised Date:  2013-12-12    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e70-6     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Area Under Curve
Child
Child, Preschool
Confidence Intervals
Female
Heart Diseases / therapy
Hospital Mortality*
Humans
Infant
Intensive Care Units, Pediatric*
Male
Nervous System Diseases / therapy
Predictive Value of Tests
Prospective Studies
ROC Curve
Sepsis / therapy
Severity of Illness Index*
Tertiary Care Centers
Time Factors
Comments/Corrections
Comment In:
Pediatr Crit Care Med. 2013 Sep;14(7):734   [PMID:  24162966 ]
Pediatr Crit Care Med. 2013 Sep;14(7):734-5   [PMID:  24162967 ]

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