Q2Objective: To determine the
concordance of mortality risk classification
through the use of the Pediatric Index of
Mortality (PIM) 2 and 3.
Methods: Through a retrospective
cohort, we evaluated patients admitted to
the pediatric intensive care unit between
April 2016 and December 2018. We
calculated the mortality risk with the
PIM 2 and 3. Analyses were carried out
to determine the concordance between
the risk classification obtained with both
scales using unweighted and linearly
weighted kappa.
Results: A total of 722 subjects were
included, and 66.6% had a chronic
condition. The overall mortality was
3.7%. The global kappa concordance
coefficient for classifying patients
according to risk with the PIM 2 and 3 was
moderate at 0.48 (95%CI 0.43 - 0.53).
After linear weighting, concordance was
substantial at 0.64 (95%CI 0.59 - 0.69).
For cardiac surgery patients, concordance
for risk classification was fair at 0.30
(95%CI 0.21 - 0.39), and after linear
weighting, concordance was only
moderate at 0.49 (95%CI 0.39 - 0.59).
The PIM 3 assigned a lower risk than
the PIM 2 in 44.8% of patients in this
subgroup.
Conclusion: Our study proves
that the PIM 2 and 3 are not clinically
equivalent and should not be used
interchangeably for quality evaluation
across pediatric intensive care units.
Validation studies must be performed
before using the PIM 2 or PIM 3 in
specific settings.Revista Internacional - Indexad
