The pediatric index of mortality 3 score to predict mortality in  a pediatric intensive care unit in Palembang, South Sumatera, Indonesia

Destiana Sera Puspita Sari; Indra Saputra; Silvia Triratna; Mgs. Irsan Saleh

doi:10.14238/pi57.3.2017.164-70

Destiana Sera Puspita Sari Department of Child Health, Sriwijaya University Medical School/Dr. Mohammad Hoesin Hospital, Palembang, South Sumatera http://orcid.org/0000-0002-1784-1418
Indra Saputra Department of Child Health, Sriwijaya University Medical School/Dr. Mohammad Hoesin Hospital, Palembang, South Sumatera
Silvia Triratna Department of Child Health, Sriwijaya University Medical School/Dr. Mohammad Hoesin Hospital, Palembang, South Sumatera
Mgs. Irsan Saleh Department of Child Health, Sriwijaya University Medical School/Dr. Mohammad Hoesin Hospital, Palembang, South Sumatera

DOI: https://doi.org/10.14238/pi57.3.2017.164-70

Keywords: PIM3 score, probability of mortality, PICU MHH Palembang

Abstract

Background 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 Â 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%). Subjectsâ€™ 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.

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