Application of the Pediatric Index of Mortality 2 in pediatric patients with complex chronic conditions

Fonseca, Jaisson Gustavo da; Ferreira, Alexandre Rodrígues

doi:10.1016/j.jped.2014.01.010

Cited by 12 publications

(14 citation statements)

References 20 publications

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“…In contrast to other studies that indicate a relationship between functional status at discharge, assessed by the Pediatric Cerebral Performance Category (PCPC) and the Pediatric Outcome Performance Category (POPC), and predictive mortality rates at admission, ( 5 , 14 , 15 ) in this study, we did not observe a significant difference in admission PIM2 values, according to the impairment in the overall FSS score presented by individuals at discharge from the PICU . This can be explained by Fonseca et al, ( 16 ) who verified that the PIM2 proved to be an inadequate measure to predict the mortality of patients with chronic conditions, which seems to be the case of the population in our study, in which only 16% individuals did not present any health condition prior to hospitalization in the PICU. The authors note the inclusion of few prediction variables to assess these conditions as a limitation of the PIM2, ( 16 ) in addition to considering only the first hour of patient hospitalization, as clinical conditions can vary dramatically within the first 24 hours of hospitalization.…”

Section: Discussionmentioning

confidence: 51%

“…This can be explained by Fonseca et al, ( 16 ) who verified that the PIM2 proved to be an inadequate measure to predict the mortality of patients with chronic conditions, which seems to be the case of the population in our study, in which only 16% individuals did not present any health condition prior to hospitalization in the PICU. The authors note the inclusion of few prediction variables to assess these conditions as a limitation of the PIM2, ( 16 ) in addition to considering only the first hour of patient hospitalization, as clinical conditions can vary dramatically within the first 24 hours of hospitalization. ( 17 )…”

Section: Discussionmentioning

confidence: 51%

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Functional evaluation of pediatric patients after discharge from the intensive care unit using the Functional Status Scale

Pereira¹,

Schaan²,

Ferrari³

2017

Revista Brasileira De Terapia Intensiva

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ObjectiveTo evaluate the functional status of pediatric patients after discharge from the pediatric intensive care unit using the Functional Status Scale and to compare the time of invasive mechanical ventilation, length of stay in the pediatric intensive care unit, and Pediatric Index of Mortality 2 results among individuals with different degrees of functional impairment.MethodsA cross-sectional study was conducted on patients who were discharged from a pediatric intensive care unit. The functional evaluation by the Functional Status Scale was performed on the first day after discharge from the unit, and the Pediatric Index of Mortality 2 was used to predict the mortality rate at the time of admission to the pediatric intensive care unit.ResultsThe sample consisted of 50 individuals, 60% of which were male, with a median age of 19 [6 - 61] months. The overall score of the Functional Status Scale was 11.5 [7 - 15], and the highest scores were observed in the "motor function" 3 [1 - 4] and "feeding" 4 [1 - 4] domains. Compared to patients who were not readmitted to the pediatric intensive care unit, patients who were readmitted presented a worse overall score (p = 0.01), worse scores in the "motor function" (p = 0.01), "feeding" (p = 0.02), and "respiratory" (p = 0.036) domains, and a higher mortality rate according to the Pediatric Index of Mortality 2 (p = 0.025).ConclusionEvaluation of the functional status using the Functional Status Scale indicated moderate impairment in patients after discharge from the pediatric intensive care unit, mainly in the "motor function" and "feeding" domains; patients who were readmitted to the pediatric intensive care unit demonstrated worse overall functional, motor function, feeding and respiratory scores. Individuals with greater functional impairment had longer times of invasive mechanical ventilation and hospitalization in the pediatric intensive care unit.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 51%

Functional evaluation of pediatric patients after discharge from the intensive care unit using the Functional Status Scale

Pereira¹,

Schaan²,

Ferrari³

2017

Revista Brasileira De Terapia Intensiva

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“…After adjusting for illness severity, various studies have reported that having an increasing number of chronic conditions was associated with increasing odds of mortality 11 19 22 25. Fonseca and Ferreira26 reported the performance of PIM2 with chronic conditions in Brazil and found that the increased mortality of patients with chronic conditions could not be verified by the probability of death estimated by PIM2. The similar probabilities between patients with and without chronic conditions may indicate poor score performances 26.…”

Section: Discussionmentioning

confidence: 99%

“…Fonseca and Ferreira26 reported the performance of PIM2 with chronic conditions in Brazil and found that the increased mortality of patients with chronic conditions could not be verified by the probability of death estimated by PIM2. The similar probabilities between patients with and without chronic conditions may indicate poor score performances 26. Edwards et al 11 also reported that patients with chronic conditions had significantly higher risks of mortality in the PICU than that predicted by PIM2 11…”

Section: Discussionmentioning

confidence: 99%

Causes of death in critically ill paediatric patients in Japan: a retrospective multicentre cohort study

Ishihara

Tanaka

2019

bmjpo

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ObjectivesThe primary objective is to clarify the clinical profiles of paediatric patients who died in intensive care units (ICUs) or paediatric intensive care units (PICUs), and the secondary objective is to ascertain the demographic differences between patients who died with and without chronic conditions.MethodsIn this retrospective multicentre cohort study, we collected data on paediatric death from the Japanese Registry of Pediatric Acute Care (JaRPAC) database. We included patients who were ≤16 years of age and had died in either a PICU or an ICU of a participating hospital between April 2014 and March 2017. The causes of death were compared between patients with and without chronic conditions.ResultsTwenty-three hospitals participated, and 6199 paediatric patients who were registered in the JaRPAC database were included. During the study period, 126 (2.1%) patients died (children without chronic illness, n=33; children with chronic illness, n=93). Twenty-five paediatric patients died due to an extrinsic disease, and there was a significant difference in extrinsic diseases between the two groups (children without chronic illness, 15 (45%); children with chronic illness, 10 (11%); p<0.01). Cardiovascular disease was the most common chronic condition (27/83, 29%). Eighty-three patients (85%) in the chronic group died due to an intrinsic disease, primarily congenital heart disease (14/93, 15%), followed by sepsis (13/93, 14%).ConclusionsThe majority of deaths were in children with a chronic condition. The major causes of death in children without a chronic illness were due to intrinsic factors such as cardiovascular and neuromuscular diseases, and the proportion of deaths due to extrinsic causes was higher in children without chronic illness.

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“…The classification system has also been used to support the development of study measures: illness severity and multimorbidity (Keele, Keenan, Sheetz, & Bratton, 2013; Lindley, 2017; Lindley & Keim-Malpass, 2017). Finally, the system has been utilized in the development of pediatric indices (daFonseca & Ferreira, 2014). Thus, the original CCC classification system is considered the gold standard in identifying children with life-limiting illness.…”

Section: Classification Systems Of Pediatric Complex Chronis Conditionsmentioning

confidence: 99%

Pediatric Complex Chronic Conditions: Evaluating Two Versions of the Classification System

2019

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The original pediatric complex chronic conditions (CCC) classification system developed in 2000/2001 is the gold standard in classifying children with life-limiting illnesses. It was significantly modified in 2014; yet the two systems have not been evaluated. The objective of this study was to evaluate the agreement and validity of the original versus the modified CCC classification systems. Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) data from 2012 was used with a sample of infant decedents less than 1 years. The agreement (i.e., Cohen’s Kappa Statistic) and validity (i.e., sensitivity, specificity, and positive predictive value [PPV]) statistics were calculated. Among the 10,175 infants that were classified, the modified system performed well in identifying infants who had a CCC, and it captured infants that the original classification did not. The modified system represents an improvement over the original, but additional testing is warranted.

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Application of the Pediatric Index of Mortality 2 in pediatric patients with complex chronic conditions

Abstract: PIM2 showed poor performance in patients with CCCs and in the general population. This result may be secondary to differences in the characteristics between the study samples (high prevalence of patients with CCCs); the performance of the PIM2 should not be ruled out.

Cited by 12 publications

References 20 publications

Functional evaluation of pediatric patients after discharge from the intensive care unit using the Functional Status Scale

Functional evaluation of pediatric patients after discharge from the intensive care unit using the Functional Status Scale

Causes of death in critically ill paediatric patients in Japan: a retrospective multicentre cohort study

Pediatric Complex Chronic Conditions: Evaluating Two Versions of the Classification System

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