Pediatric Index of Mortality 3 score as a predictor for the outcomes of critically ill patients

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Gusti Ayu Nyoman Yulia Sitta Dewi
Dyah Kanya Wati
Made Gede Dwi Lingga Utama
Ketut Suarta Suarta
I Wayan Darma Artana
Made Sukmawati


Background The ability to predict mortality in critically ill patients is important for assessing patient prognosis, evaluating therapy, and assessing intensive care unit quality. The Pediatric Index of Mortality (PIM) 3 is a scoring system to predict outcomes in order to assist clinical decision-making.
Objective To assess the ability of PIM 3 to predict outcomes of critically ill PICU patients.
Methods This prospective cohort study included 150 children aged 1 month to 18 years who were admitted to the pediatric intensive care unit (PICU), Sanglah Hospital, Denpasar, Bali. Subjects were grouped into two based on ROC curve PIM score ≥48 and <48. The PIM 3 score was consisted of 10 variables, with a re-diagnosis classification of the PIM 2 score. Bivariate analysis was conducted to both groups to find the distribution of mortality in both groups, followed by homogenity test on variables gender, age, nutritional status, lenght of stay and mechanical ventilation. Variables which made the cut on bivariate test were included in multivariate analysis.
Results The optimal PIM 3 score limit in predicting mortality was ≥48, with area under the curve (AUC) 76% (95%CI 0.69 to 0.85). Multivariate analysis revealed a 2.48 times increased risk to mortality in patients with PIM 3 score ≥48 (95%CI 1.6 to 3.7). In addition, PICU length of stay ≤7 days was a significant risk factor for mortality.
Conclusion The PIM 3 has a good ability to predict the outcome of critically ill PICU patients. Critically ill patients with PIM 3 score ≥48 have a higher risk of mortality compared to those with PIM 3 < 48.

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How to Cite
Dewi GAN, Wati D, Utama MG, Suarta K, Artana IW, Sukmawati M. Pediatric Index of Mortality 3 score as a predictor for the outcomes of critically ill patients. PI [Internet]. 13Nov.2020 [cited 26Jan.2021];60(6). Available from:
Emergency & Pediatric Intensive Care
Received 2020-03-20
Accepted 2020-11-13
Published 2020-11-13


1. WHO. Updated guideline: Paediatric emergency triage, assessment and treatment: care of critically-ill children. Geneva: WHO; 2016. p.7.
2. Gulla K, Sachdev A. Illness severity and organ dysfunction scoring in pediatric intensive care unit. Indian J Crit Care Med. 2016;20:27-35. DOI: 10.4103/0972-5229.173685.
3. UKK Emergensi dan Rawat Intensif Anak IDAI. Rawat Intensif. In: Latief A, Pudjiadi AH, Kushartono H, Malisie RF, editors. Pelayanan Emergensi, Rawat Intermediet dan Rawat Intensif Anak. Jakarta: Badan Penerbit Ikatan Dokter Anak Indonesia; 2016. p.1-36.
4. Bhadoria P, Bhagwat A. Severity scoring in paediatric intensive care units. Indian J Anaesth. 2008;52:663-75.
5. Straney L, Clements A, Parslow RC, Pearson G, Shann F, Alexander J, et al. Paediatric index of mortality 3: an updated model for predicting mortality in pediatric intensive care. Pediatr Crit Care Med. 2013;14:673-81. DOI: 10.1097/PCC.0b013e31829760cf.
6. Dahlan S. Prognostik. In: Dahlan S, editor. Besar sampel dalam penelitian kedokteran dan kesehatan. 4th ed. Jakarta: Epidemiologi Indonesia; 2016. p.7.
7. Hao TK, Son NH. Mortality Pattern at Pediatric Intensive Care Unit Of Hue Central Hospital, Vietnam. Biomed J Sci & Tech Res 11(5)-2018. BJSTR. MS.ID.002155.
DOI: 10.26717/ BJSTR.2018.11.002155.
8. Sudarmadji S, Wati DK, Sidiartha L. Faktor risiko pada lama rawat dan luaran pasien perawatan di unit perawatan intensif anak RSUP Sanglah Denpasar. Sari Pediatri. 2016;17:455-62. DOI: 10.14238/sp17.6.2016.455-62.
9. Jyothi KA, Ankireddy K. A study on clinical profile and outcome of patients in PICU (paediatric intensive care unit) at tertiary care unit. Int J Contemp Pediatr. 2019;6:757-60. DOI: 10.18203/2349-3291.ijcp20190725.
10. Assa N, Wati D, Subanada I, Soetjiningsih S, Kardana M, Sukmawati M. Full outline of unresponsiveness score as a predictor of outcomes in critically ill pediatric patients. 2020;60:77-2. DOI: 10.14238/pi60.2.2020.77-82.
11. Chen MY, Yang YJ. Being underweight is an independent risk factor for poor outcomes among acutely critically ill children. Nutr Clin Pract. 2018;33: 4338.
DOI: 10.1177/0884533617712225.
12. Correia, MITD, Waitzberg, DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and cost evaluated through a multivariate model analysis. Clinical nutrition.2003;22:235-9. DOI: 10.1016/S0261-5614(02)00215-7.
13. Mukhtar B, Siddiqui NR, Haque A. Clinical characteristics and immediate-outcome of children mechanically ventilated in PICU of Pakistan. Pak J Med Sci. 2014;30;927-30.
DOI: 10.12669/pjms.305.5159.
14. Azevedo LCP, Park M, Salluh JIF, Rea-Neto A, Souza-Dantas VC, Varaschin P, et al. Clinical outcomes of patients requiring ventilator support in Brazillian intensive care units: a multicenter, prospective, cohort study. Crit Care. 2013;17:R63. DOI: 10.1186/cc12594.
15. Gonzalez-Cortés R, López-Herce-Cid J, Garcia-Figueruelo A, Tesorero-Carcedo G, Botran-Prieto M, Carrillo-Álvarez A. Prolonged stay in pediatric intensive care units: mortality and healthcare resource consumption. Med Intensiva. 2011;35;417-23. DOI: 10.1016/j.medin.2011.04.004.
16. Kirk AH, Sng QW, Zhang LQ, Wong JJ, Puthucheary J, Lee JH. Characteristics and outcomes of long-stay patients in the pediatric intensive care unit. J Pediatr Intensive Care.
2018; 7: 1-6. DOI: 10.1055/s-0037-1601337.
17. Indradjaja A, Suparyatha IB, Hartawan IN. The association between serum albumin levels and mortality in pediatric intensive care unit of Sanglah Hospital Denpasar. MEDICINA. 2014;45:13-8.