1. The Importance of Mortality Risk Assessment: Validation of the Pediatric Index of Mortality 3 Score
- Author
-
Wolfler, Andrea, Osello, Raffaella, Gualino, Jenny, Calderini, Edoardo, Vigna, Gianluca, Santuz, Pierantonio, Amigoni, Angela, Savron, Fabio, Caramelli, Fabio, Rossetti, Emanuele, Cecchetti, Corrado, Corbari, Maurizio, Piastra, Marco, Testa, Raffaele, Coffaro, Giancarlo, Stancanelli, Giusi, Gitto, Eloisa, Amato, Roberta, Prinelli, Federica, Salvo, Ida, Racca, F., Ferrero, F., Zoia, E., Mandelli, A., Montani, C., Prandi, E., Molinaro, S., Biban, P., Pettenazzo, A., Furlan, S., Mondardini, C., Iannella, E., Perrotta, D., Picardo, S., Conti, Giorgio, Genovese, O., Dolcini, Andrea, D Amato, L., Guddo, A. M., and Giglio, A. M.
- Subjects
Pediatrics ,medicine.medical_specialty ,Index (economics) ,Adolescent ,standardized mortality ratio ,children risk of mortality outcome/quality measure pediatric intensive care unit standardized mortality ratio validation studies ,MEDLINE ,Critical Care and Intensive Care Medicine ,Intensive Care Units, Pediatric ,Risk Assessment ,National cohort ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,children ,030225 pediatrics ,Settore MED/41 - ANESTESIOLOGIA ,risk of mortality ,medicine ,Health Status Indicators ,Humans ,030212 general & internal medicine ,Hospital Mortality ,Prospective cohort study ,Child ,validation studies ,business.industry ,Children, Outcome/quality measure ,Pediatric intensive care unit, Risk of mortality, Standardized mortality ratio, Validation studies, Pediatrics, Perinatology and Child Health, Medicine (all), Critical Care and Intensive Care Medicine ,Infant, Newborn ,Infant ,Children ,Outcome/quality measure ,Pediatric intensive care unit ,Risk of mortality ,Standardized mortality ratio ,Validation studies ,Pediatrics, Perinatology and Child Health ,quality measure ,Risk adjustment ,Perinatology and Child Health ,Italy ,ROC Curve ,Child, Preschool ,outcome ,Risk Adjustment ,Risk assessment ,business ,pediatric intensive care unit ,Cohort study - Abstract
OBJECTIVE: To evaluate the performance of the newest version of the Pediatric Index of Mortality 3 score and compare it with the Pediatric Index of Mortality 2 in a multicenter national cohort of children admitted to PICU. DESIGN: Retrospective, prospective cohort study. SETTING: Seventeen Italian PICUs. PATIENTS: All children 0 to 15 years old admitted in PICU from January 2010 to October 2014. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Eleven thousand one hundred nine children were enrolled in the study. The mean Pediatric Index of Mortality 2 and 3 values of 4.9 and 3.9, respectively, differed significantly (p < 0.05). Overall mortality rate was 3.9%, and the standardized mortality ratio was 0.80 for Pediatric Index of Mortality 2 and 0.98 for Pediatric Index of Mortality 3 (p < 0.05). The area under the curve of the receiver operating characteristic curves was similar for Pediatric Index of Mortality 2 and Pediatric Index of Mortality 3. The Hosmer-Lemeshow test was not significant for Pediatric Index of Mortality 3 (p = 0.21) but was highly significant for Pediatric Index of Mortality 2 (p < 0.001), which overestimated death mainly in high-risk categories. CONCLUSIONS: Mortality indices require validation in each country where it is used. The new Pediatric Index of Mortality 3 score performed well in an Italian population. Both calibration and discrimination were appropriate, and the score more accurately predicted the mortality risk than Pediatric Index of Mortality 2.
- Published
- 2016
- Full Text
- View/download PDF