Assessing Pediatric Index of Mortality2 Score and Factors Affecting Outcome of Patients Admitted to Pediatric Intensive Care Unit in SPHMMC, Addis Ababa, Ethiopia, 2016 to 2019

Abstract

Abstract Background: Mortality reduction is the fundamental aim of a Pediatric Intensive Care Unit (PICU). Pediatric Index of Mortality2 (PIM2) is one of mortality scoring methods which can be used to predict mortality, to assess quality of care and to determine severity of illness in pediatric intensive care units (PICUs). Despite PIM2 is regarded to be a better tool, its use has not been well validated in Ethiopia. The objective of this study was to evaluate the applicablity of PIM2 score in predicting mortality in a tertiary care pediatric ICU and to assess associated factors in predicting mortality. Method: A health institution based cross sectional study was conducted on 282 PICU admitted children to SPHMMC from 2016 to 2019. An adopted checklist was used to collect data from patient records from July 01-30, 2019. Data was entered and analyzed using SPSS version 23. The predictive ability of PIM2 score for patient mortality was analyzed using Reciver Operative Characteristics (ROC) curve and the corresponding sensitivity and specificity of the PIM2 model was calculated. Multiple binary logistic regression was conducted and P-value <0.05 was considered statistically significant. Results: A total of 282 patients were included in this study. The predicted mortality by PIM2 score was 11.8% (n=34) while the observed mortality was 39.7% (n=112). Neurological diseases contributed to 33.0% mortality followed by cardiac 14.3% and renal diseases 13.4%. PIM2 score discriminated well between death and survival with area under receiver operating characteristic curve 0.86 (95%CI 0.82 to 0.91) and with sensitivity of 75% and specificity 83.5%. Significant statistical association with mortality was seen in children who required mechanical ventilation Adjusted Odd’s Ratio (AOR) 9.2 (95%CI 2.65 to 31.9), children with high risk diagnosis (AOR 8.4 (95%CI 4.17 to 16.8) and in those with dilated pupils at admission AOR 9.4 (95%CI 1.37 to 64.5). Conclusion: PIM2 model has a good discriminatory power, it discriminated well between survivors and death at PICU and therefore is recommended for routine use in clinical practice. Mortality was more likely in children who required mechanical ventilation at admission, have a high risk diagnosis and dilated pupils. Key words: Pediatric index of mortality children, mortality, PICU