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International comparison of the performance of the paediatric index of mortality (PIM) 2 score in two national data sets

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Abstract

Objectives

To test the performance of PIM2 in French-speaking (FS) paediatric intensive care units (PICUs) and its relative performance when recalibrated using data from FS and Great Britain (GB) PICUs of different size.

Methods

Consecutive admissions to 15 FS (n = 5,602) and 31 GB PICUs (n = 20,693) from June 2006 to October 2007 were included. The recalibrated PIM2 were applied to PICUs of different size within the FS and GB PICUs and between the two groups. PICU size was defined using number of admissions/month. Discrimination and calibration were evaluated using the area under the ROC curve (AUC) and the goodness-of-fit test, respectively. Logistic regression, funnel plots and standardized W scores were performed in the two groups and between different PICU sizes.

Results

In FS PICUs, the original PIM2 had good discrimination (AUC = 0.85) and moderate calibration (p = 0.07). The recalibrated PIM2 scores had good calibration in FS (p = 0.33) and moderate calibration in GB (p = 0.06). Calibration was poor when the recalibrated FS PIM2 was applied to GB (p = 0.02) but good when the GB recalibration was applied to the FS (p = 0.36). Using the original PIM2 coefficients, calibration was poor in large units in both groups but improved following recalibration. There were no effects of PICU size on risk-adjusted mortality in GB and a significant effect in the FS PICUs with a minimum risk-adjusted mortality at about 35 admissions/month.

Conclusion

The PIM2 score was valid in the FS population. The recalibration based on GB data could be applied to FS PICUs. Such recalibration may facilitate comparisons between countries.

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References

  1. Lacroix J, Cotting J (2005) Severity of illness and organ dysfunction scoring in children. Pediatr Crit Care Med 6:S126–S134

    Article  PubMed  Google Scholar 

  2. Martinot A, Leteurtre S, Grandbastien B, Duhamel A, Leclerc F (1997) Characteristics of patients and use of resource in French pediatric intensive care units. Arch Pediatr 4:730–736

    Article  PubMed  CAS  Google Scholar 

  3. Slater A, Shann F (2004) The suitability of the pediatric index of mortality (PIM), PIM2, the pediatric risk of mortality (PRISM), and PRISM III for monitoring the quality of pediatric intensive care in Australia and New Zealand. Pediatr Crit Care Med 5:447–454

    Article  PubMed  Google Scholar 

  4. Wunsch H, Rowan KM, Angus DC (2007) International comparisons in critical care: a necessity and challenge. Curr Opin Crit Care 13:725–731

    Article  PubMed  Google Scholar 

  5. LaRovere JM, Jeffries HE, Sachdeva RC, Rice TB, Wetzel RC, Cooper DS, Bird GL, Ghanayem NS, Checchia PA, Chang AC, Wessel DL (2008) Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease: the perspective of critical care. Cardiol Young 18(Suppl 2):130–136

    Article  PubMed  Google Scholar 

  6. Parslow RC, Tasker RC, Draper ES, Parry GJ, Jones S, Chater T, Thiru K, McKinney PA (2009) Epidemiology of critically ill children in England and Wales: incidence, mortality, deprivation and ethnicity. Arch Dis Child 94:210–215

    Article  PubMed  CAS  Google Scholar 

  7. Slater A, Shann F, McEniery J (2003) The ANZPIC registry diagnostic codes: a system for coding reasons for admitting children to intensive care. Intensive Care Med 29:271–277

    PubMed  Google Scholar 

  8. Pollack MM, Patel KM, Ruttimann UE (1996) PRISM III: an updated pediatric risk of mortality score. Crit Care Med 24:743–752

    Article  PubMed  CAS  Google Scholar 

  9. Slater A, Shann F, Pearson G (2003) PIM2: a revised version of the paediatric index of mortality. Intensive Care Med 29:278–285

    PubMed  Google Scholar 

  10. Brady AR, Harrison D, Black S, Jones S, Rowan K, Pearson G, Ratcliffe J, Parry GJ (2006) Assessment and optimization of mortality prediction tools for admissions to pediatric intensive care in the United Kingdom. Pediatrics 117:e733–e742

    Article  PubMed  Google Scholar 

  11. Chase JG, Shaw GM (2012) How standard is the “S” in SMR? Intensive Care Med 38:1–3

    Article  PubMed  Google Scholar 

  12. Minne L, Eslami S, de Keizer N, de Jonge E, de Rooij SE, Abu-Hanna A (2012) Effect of changes over time in the performance of a customized SAPS-II model on the quality of care assessment. Intensive Care Med 38:40–46

    Article  PubMed  CAS  Google Scholar 

  13. Vincent JL, Moreno R (2010) Clinical review: scoring systems in the critically ill. Crit Care 14:207

    Article  PubMed  Google Scholar 

  14. Wolfler A, Silvani P, Musicco M, Salvo I (2007) Pediatric index of mortality 2 score in Italy: a multicenter, prospective, observational study. Intensive Care Med 33:1407–1413

    Article  PubMed  Google Scholar 

  15. Tilford JM, Simpson PM, Green JW, Lensing S, Fiser DH (2000) Volume-outcome relationships in pediatric intensive care units. Pediatrics 106:289–294

    Article  PubMed  CAS  Google Scholar 

  16. Cogo PE, Poole D, Codazzi D, Boniotti C, Capretta A, Langer M, Luciani D, Rossi C, Bertolini G (2010) Outcome of children admitted to adult intensive care units in Italy between 2003 and 2007. Intensive Care Med 36:1403–1409

    Article  PubMed  Google Scholar 

  17. Pollack MM (2007) Pediatric intensive care quality factors. J Trauma 63:S143–S145

    Article  PubMed  Google Scholar 

  18. Marcin JP, Song J, Leigh JP (2005) The impact of pediatric intensive care unit volume on mortality: a hierarchical instrumental variable analysis. Pediatr Crit Care Med 6:136–141

    Article  PubMed  Google Scholar 

  19. Pollack MM, Cuerdon TT, Patel KM, Ruttimann UE, Getson PR, Levetown M (1994) Impact of quality-of-care factors on pediatric intensive care unit mortality. JAMA 272:941–946

    Article  PubMed  CAS  Google Scholar 

  20. Ruttimann UE, Patel KM, Pollack MM (2000) Relevance of diagnostic diversity and patient volumes for quality and length of stay in pediatric intensive care units. Pediatr Crit Care Med 1:133–139

    Article  PubMed  CAS  Google Scholar 

  21. Shahian DM, Normand SL (2008) Comparison of “risk-adjusted” hospital outcomes. Circulation 117:1955–1963

    Article  PubMed  Google Scholar 

  22. Cevenini G, Barbini P (2010) A bootstrap approach for assessing the uncertainty of outcome probabilities when using a scoring system. BMC Med Inform Decis Mak 10:45

    Article  PubMed  Google Scholar 

  23. Lemeshow S, Hosmer DW Jr (1982) A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol 115:92–106

    PubMed  CAS  Google Scholar 

  24. Hollis S, Yates DW, Woodford M, Foster P (1995) Standardized comparison of performance indicators in trauma: a new approach to case-mix variation. J Trauma 38:763–766

    Article  PubMed  CAS  Google Scholar 

  25. Glance LG, Osler T, Shinozaki T (2000) Effect of varying the case mix on the standardized mortality ratio and W statistic: a simulation study. Chest 117:1112–1117

    Article  PubMed  CAS  Google Scholar 

  26. Ashley A, Draper E, Fleming T, Lamming C, McKinney P, McShane P, Parslow R, Skinner S, Thiru K (2009) National Report of the Paediatric Intensive Care Audit Network 2006–2008. Leeds. http://www.picanet.org.uk/Documents/General/Annual%20report_2009/PICANet%20National%20Report%202006%20-%202008_new.pdf. Accessed 12 Nov 2011

  27. Eulmesekian PG, Perez A, Minces PG, Ferrero H (2007) Validation of pediatric index of mortality 2 (PIM2) in a single pediatric intensive care unit of Argentina. Pediatr Crit Care Med 8:54–57

    Article  PubMed  Google Scholar 

  28. Imamura T, Nakagawa S, Goldman RD, Fujiwara T (2012) Validation of pediatric index of mortality 2 (PIM2) in a single pediatric intensive care unit in Japan. Intensive Care Med 38:649–654

    Google Scholar 

  29. Leteurtre S, Martinot A, Duhamel A, Proulx F, Grandbastien B, Cotting J, Gottesman R, Joffe A, Pfenninger J, Hubert P, Lacroix J, Leclerc F (2003) Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet 362:192–197

    Article  PubMed  Google Scholar 

  30. Metnitz B, Schaden E, Moreno R, Le Gall JR, Bauer P, Metnitz PG (2009) Austrian validation and customization of the SAPS 3 admission score. Intensive Care Med 35:616–622

    Article  PubMed  Google Scholar 

  31. Bakhshi-Raiez F, Peek N, Bosman RJ, de Jonge E, de Keizer NF (2007) The impact of different prognostic models and their customization on institutional comparison of intensive care units. Crit Care Med 35:2553–2560

    Article  PubMed  Google Scholar 

  32. Gregory CJ, Nasrollahzadeh F, Dharmar M, Parsapour K, Marcin JP (2008) Comparison of critically ill and injured children transferred from referring hospitals versus in-house admissions. Pediatrics 121:e906–e911

    Article  PubMed  Google Scholar 

  33. Alexander J, Tregea S, Slater A (2010) Report of the Australian and New Zealand Paediatric Intensive Care Registry 2009. Available at http://www.anzics.com.au/core/anzpicr?start=2. Accessed 10 Sept 2011

  34. Straney LD, Clements A, Alexander J, Slater A (2010) Measuring efficiency in Australian and New Zealand paediatric intensive care units. Intensive Care Med 36:1410–1416

    Article  PubMed  Google Scholar 

  35. Haub C (2010) 2010 world population data sheet. Population Reference Bureau, Washington, DC. http://www.prb.org/pdf10/10wpds_eng.pdf. Accessed 4 May 2011

  36. Beyene J, Atenafu EG, Hamid JS, To T, Sung L (2009) Determining relative importance of variables in developing and validating predictive models. BMC Med Res Methodol 9:64

    Article  PubMed  Google Scholar 

  37. Murphy-Filkins R, Teres D, Lemeshow S, Hosmer DW (1996) Effect of changing patient mix on the performance of an intensive care unit severity-of-illness model: how to distinguish a general from a specialty intensive care unit. Crit Care Med 24:1968–1973

    Article  PubMed  CAS  Google Scholar 

  38. Metnitz B, Metnitz PG, Bauer P, Valentin A (2009) Patient volume affects outcome in critically ill patients. Wien Klin Wochenschr 121:34–40

    Article  PubMed  Google Scholar 

  39. Glance LG, Szalados JE (2002) Benchmarking in critical care: the road ahead. Chest 121:326–328

    Article  PubMed  Google Scholar 

  40. Macrae D (2009) Conducting clinical trials in pediatrics. Crit Care Med 37:S136–S139

    Article  PubMed  Google Scholar 

  41. Spiegelhalter D (2002) Funnel plots for institutional comparison. Qual Saf Health Care 11:390–391

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Phil McShane (Paediatric Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK) for his help in the statistical analysis. French database: Grant from the French ministry of Health. UK database: PICANet is funded by the National Clinical Audit and Patient Outcomes Programme via Healthcare Quality Improvement Partnership (HQIP), Health Commission Wales Specialised Services, NHS Lothian/National Service Division NHS Scotland, the Royal Belfast Hospital for Sick Children, Our Lady’s Children’s Hospital, Crumlin, Children’s University Hospital, Temple Street and The Harley Street Clinic, London.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Paediatric Intensive Care Unit, Jeanne de Flandre University Hospital, 59037, Lille Cedex, France

    Stéphane Leteurtre & Francis Leclerc

  2. Department of Epidemiology and Public Health, Calmette Hospital, 59037, Lille Cedex, France

    Bruno Grandbastien

  3. Univ Lille Nord de France, UDSL, EA2694, 1, place de Verdun, 59045, Lille Cedex, France

    Stéphane Leteurtre, Bruno Grandbastien & Francis Leclerc

  4. Paediatric Epidemiology Group, Centre for Epidemiology and Biostatistics, 8.49 Worsley Building, University of Leeds, Leeds, LS2 9JT, UK

    Roger Parslow

Authors
  1. Stéphane Leteurtre
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  2. Bruno Grandbastien
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  3. Francis Leclerc
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  4. Roger Parslow
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Consortia

Groupe Francophone de Réanimation et Urgences Pédiatriques

Paediatric Intensive Care Audit Network

Corresponding author

Correspondence to Stéphane Leteurtre.

Additional information

Groupe Francophone de Réanimation et Urgences Pédiatriques (GFRUP): The members of the GFRUP who participated in this study are listed in the Appendix.

Paediatric Intensive Care Audit Network (PICANet): We are grateful to all the audit clerks, secretaries, nurses and doctors who support and contribute to PICANet from their own PICUs, the Paediatric Intensive Care Society, the Paediatric Intensive Care Society Study Group, the PICANet Steering Group and the PICANet Clinical Advisory Group.

Electronic supplementary material

Below is the link to the electronic supplementary material.

134_2012_2580_MOESM1_ESM.doc

Fig.1 Description of the study’s design.PIM paediatric index of mortality, PICU paediatric intensive care unit. Fig. 2 Calibration plots in GB and FS PICUs. Plots show the observed risk by expected risk in deciles of expected risk using a log scale. The Hosmer–Lemeshow test indicated lack of fit for GB PIM2 score (p = 0.0011), moderate fit for FS PIM2 score (p = 0.07) and GB-Rec-PIM2 score (p = 0.06) and adequate fit for FS-Rec-PIM2 (p = 0.33).PIM paediatric index of mortality.Fig. 3 Relationship between admission per month and standardized mortality ratio in the FS (a) and GB (b) PICUs. Supplementary material 1 (DOC 285 kb)

Appendix

Appendix

Members of the GFRUP who participated D. Biarent (Bruxelles, Belgium), T. Blanc (Rouen, France), S. Cantagrel (Tours, France), R. Cremer (Lille, France), S. Dauger (Paris, France), P. Desprez (Strasbourg, France), M. Dobrzynski (Brest, France), G. Emériaud (Grenoble, France), P. Hubert (Paris, France), C. Milesi (Montpellier, France), S. Renolleau (Paris, France), M. Roque-Gineste (Toulouse, France), O. Noizet-Yverneau (Reims, France), D. Stamm (Lyon, France), I. Wroblewski (Besançon, France).

Participating French-speaking hospitals Data were collected in the French NPICU/PICUs of the following centres: American Memorial Hospital, CHU de Reims, France; Hôpital Charles Nicolle, CHU de Rouen, France; Hôpital Arnaud de Villeneuve, CHU de Montpellier, France; Hôpital Clocheville, CHU de Tours, France; Hôpital des enfants, CHU de Toulouse, France; Hôpital Hautepierre, CHU de Strasbourg, France; Hôpital Jeanne de Flandre, CHU de Lille, France; Hôpital Femme Mère-enfant, Hospices Civils de Lyon, France; Hôpital Morvan, CHU de Brest, France; Hôpital Necker, Assistance Publique-Hôpitaux de Paris, France; Hôpital Nord, CHU de Grenoble, France; Hôpital Reine Fabiola, Bruxelles, Belgium; Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, France; Hôpital Saint Pierre, CHU de Besançon, France; Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, France.

Participating NHS trusts and hospitals

Addenbrooke’s NHS Trust: Addenbrooke’s Hospital

Bart’s and the London NHS Trust: Bart’s and The Royal London

Birmingham Children’s Hospital NHS Trust: Diana, Princess of Wales Children’s Hospital

Brighton & Sussex University Hospitals NHS Trust: Royal Alexandra Hospital for Sick Children

Cardiff and Vale NHS Trust: University Hospital of Wales

Central Manchester and Manchester Children’s University Hospitals NHS Trust: Royal Manchester Children’s Hospital

Children’s University Hospital, Temple Street, Dublin

Great Ormond Street Hospital for Children NHS Trust: Great Ormond Street Hospital for Sick Children

Guy’s & St. Thomas’ Hospital NHS Trust: Evelina Children’s Hospital

Hull & East Yorkshire Hospitals NHS Trust: Hull Royal Infirmary

King’s College Hospital NHS Trust: King’s College Hospital

Leeds Teaching Hospitals NHS Trust: Leeds General Infirmary, St. James University Hospital

Our Lady’s Children’s Hospital, Crumlin, Dublin

Newcastle upon Tyne Hospitals NHS Trust: Great Northern Children’s Hospital (formerly Newcastle General Hospital and the Royal Victoria Infirmary). Freeman Hospital

Oxford Radcliffe Hospitals NHS Trust: John Radcliffe Hospital

Queen’s Medical Centre Nottingham University NHS Trust: Queen’s Medical Centre

Royal Brompton and Harefield NHS Trust: Royal Brompton Hospital

Royal Liverpool Children’s NHS Trust: Alder Hey Hospital

Royal Group of Hospitals and Dental Hospital HSS Trust, Belfast Hospital for Sick Children

Sheffield Children’s NHS Trust: Sheffield Children’s Hospital

Southampton University Hospitals NHS: Trust Southampton General Hospital

South Tees Hospitals NHS Trust: James Cook University Hospital

St. George’s Healthcare NHS Trust: St. George’s Hospital

St. Mary’s NHS Trust: St. Mary’s Hospital

The Harley Street Clinic, London

The Lewisham Hospitals NHS Trust: University Hospital, Lewisham (to July 2010)

University Hospitals Bristol NHS Foundation Trust: Bristol Royal Hospital for Children

University Hospitals of Leicester NHS Trust: Leicester Glenfield Hospital, Leicester Royal Infirmary

University Hospital of North Staffordshire NHS Trust: Stoke on Trent City General

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Leteurtre, S., Grandbastien, B., Leclerc, F. et al. International comparison of the performance of the paediatric index of mortality (PIM) 2 score in two national data sets. Intensive Care Med 38, 1372–1380 (2012). https://doi.org/10.1007/s00134-012-2580-6

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