Pediatric Index of Mortality

(PIM-2)
 PIM-2
• Pediatric Index of Mortality- revised version
• Devised by Anthony Slater, Frank Shann, Gale
Pearson in 2003
• Predicted mortality for patients from data
collected at admission to PICU
• Validated in Australia, UK, New Zealand on
over 36,000 patients
 PIM-2
• Consists of ten variables
– Elective admission
– Recovery post procedure
– Cardiac bypass
– High risk diagnosis
• Cardiac arrest preceding ICU admission
• Severe combined immune deficiency
• Leukaemia or lymphoma after first induction
• Spontaneous cerebral haemorrhage
• Cardiomyopathy or myocarditis
• Hypoplastic left heart syndrome
• HIV infection
• Liver failure is the main reason for ICU admission
• Neuro-degenerative disorder
 PIM-2
• Variables (contd.)
– Low risk diagnosis
• Asthma is the main reason for ICU admission
• Bronchiolitis is the main reason for ICU admission
• Croup is the main reason for ICU admission
• Obstructive sleep apnoea is the main reason for ICU admission
• Diabetic keto-acidosis is the main reason for ICU admission
– No response of pupils to bright light
(> 3 mm and both fixed)
– Mechanical ventilation
(at any time during first hour in ICU)
– Systolic Blood Pressure (mmHg)
– Base Excess (mmHg)
(arterial or capillary blood)
– FiO2*100/ PaO2 (mmHg)
 PIM-2
• Calculation
– Data are collected from the time of first contact with
the patient by ICU staff (whether in Emergency, field,
or other ward)
– The first value of each variable recorded from time of
first contact to within 1h of admission to PICU
– If values are missing, record as 0 except systolic blood
pressure which is assigned default value of 120
– All consecutive patients are included
– Score is computed by multivariate regression equation
 PIM-2
• The final score is the predicted mortality for that
patient
• Scores collected for individual patients are
collated for the whole PICU over a period of time
• The average total score gives a predicted death
rate for a given PICU
• Not valid for predicting mortality in an individual
patient, because-
 PIM-2
• PIM-2 describes how ill a child is at admission
to the PICU
• It does not predict or evaluate a child’s course
after admission
• Hence, cannot predict eventual mortality for
that patient
• PIM-2 is however valid for groups of patients
to describe morbidity or severity of illness
 PIM-2
• Uses
– Describe severity of illness for groups of patients
– Benchmarking by measuring actual deaths vs.
predicted deaths over periods of time
– Measures quality of care if actual deaths
consistently below predicted death rate
– Inter-unit comparison of performance
– Stratification of patient groups for research