Outcome of Children In Pediatric Intensive Care Unit By Using Pediatric Index of Mortality (Pim-Ii) Score

Samina Sultana; Qudratullah Malik; Kamran Khan; Summaya Jawed; Ammara Jamil

doi:10.51253/pafmj.v76iSUPPL-9.6302

Authors

Samina Sultana Department of Paeds, Pak Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Qudratullah Malik Department of Paeds, Pak Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Kamran Khan Department of Paeds, Combined Military Hospital Rawalpindi/ National University of Medical Sciences (NUMS) Pakistan
Summaya Jawed Department of Paeds, Pak Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Ammara Jamil Department of Paeds, Pak Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-9.6302

Keywords:

Children, Pediatric index of mortality (PIM-II) score, Pediatric outcome

Abstract

Objective: To determine the outcome and associated factors of using the pediatric intensive care pediatric index of mortality (PIM-II) score in a pediatric intensive care unit for predicting mortality.

Study Design: Cross-sectional study

Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, Pakistan from August 2019 to November 2020.

Methodology: All children age 1 month to 12 years of either gender admitted in PICU were consecutively enrolled. PIM-II scoring system was used to predict mortality in PICU. Patient follow was maintained throughout the entire hospital stay, including PICU admission to record patient outcome. It was then categorized as either “discharged” or “death.”

Results: Of 105 patients, the median PIM-II score was 26 (20-41). There were 26 (24.8%) patients predicted death rate of <20%, 51 (48.6%) patients with 20-40% predicted death rate, and 28 (26.7%) patients with >40% predicted death rate. The observed mortality was reported in 36 (34.3%) patients. The odds of mortality were 99% lower among patients with predicted death rate of <20% (adjusted OR=0.01, 95% CI 0.01-0.05) and in between 20% to 40% predicted death rate (adjusted OR=0.01, 95% CI 0.01-0.05) as compared to >40% predicted death rate. The area under the curve of PIM-II was found to be 0.88 (95% CI 0.79-0.97).

Conclusion: The PIM-II score predicted accurately in most of the patients admitted in PICU and could be recommended as a valuable tool for anticipating prognosis in pediatric patients.

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References

1. Olatunji G, Kokori E, Aderinto N, Abdul A, Tsoi V, Mohamed L et al. Challenges and strategies in pediatric critical care: insights from low-resource settings. Glob Pediatr Health. 2024 Sep; 11:

https://doi.org/10.1177/2333794X241285964

2. Shann F, Pearson G, Slater A, Wilkinson K: Paediatric index mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med. 1997, 23: 201-207.

3. Ekinci F, Yildizdas D, Horoz OO, Arslan I, Ozkale Y, Yontem A et al. Performance and analysis of four pediatric mortality prediction scores among critically ill children: A multicenter prospective observational study in four PICUs. Archives de Pédiatrie. 2022; 29(6): 407-14.

https://doi.org/10.1016/j.arcped.2022.05.001.

4. Muthupandi V, Dianagrace R, Narayanan E, Sathya J. Comparison of PRISM III and PIM II Score in Predicting Mortality in Paediatric Intensive Care Unit: An Observational Study. J Clin Diagn Res. 2022 Feb 1; 16(2): 216-222.

https://www.doi.org/10.7860/JCDR/2022/51410.15971.

5. Polito A, Giacobino C, Combescure C, Levy-Jamet Y, Rimensberger P, Swiss Society of Intensive Care Medicine. Overall and subgroup specific performance of the pediatric index of mortality 2 score in Switzerland: a national multicenter study. Eur J Pediatr. 2020 Oct; 179(10): 1515-1521.

https://doi.org/10.1007/s00431-020-03639-y.

6. Joyce EL, Crana CM, Yabes J, Kellum JA. Validation of an Electronic Pediatric Index of Mortality 2 Score in a Mixed Quaternary PICU. Pediatric Critical Care Medicine. 2020 Mar 17; 21(8): e572-575.

https://www.doi.org/10.1097/PCC.0000000000002347.

7. Sajid M, Nousharwan M, Sarwar S, Laal J, Ahmad A. Clinical Accuracy of PRISM III Score in determining mortality in severely ill Pediatric patients in Pediatric ICU. J Bahria Univ Med Dent Coll. 2026 Apr 21; 16(02): 532-7.

https://doi.org/10.51985/JBUMDC2025747.

8. Mirza S, Malik L, Ahmed J, Malik F, Sadiq H, Ali S, Aziz S. Accuracy of Pediatric Risk of Mortality (PRISM) III Score in Predicting Mortality Outcomes in a Pediatric Intensive Care Unit in Karachi. Cureus. 2020 Mar; 12(3)415-421.

https://www.doi.org/10.7759/cureus.7489.

9. Tabish M, Hamid MH, Mahwish R, Haroon F. Comparison of accuracy of pediatric index of mortality-3 (PIM-3) and pediatric index of mortality-2 (PIM-2) scores in predicting outcome of children admitted to pediatric ICU of a tertiary care hospital. Pak J Med Sci. 2025 Oct; 41(10): 2764-2772.

https://www.doi.org/10.12669/pjms.41.10.12061.

10. Gandhi J, Sangareddi S, Varadarajan P, Suresh S. Pediatric index of mortality 2 score as an outcome predictor in pediatric Intensive Care Unit in India. Indian J Crit Care Med. 2013; 17(5): 288–291.

https://www.doi.org/10.4103/0972-5229.120320.

11. Usluer E, Anıl AB, Anıl M, Kamit F, Altuğ Ü, Özçifçi G et al. Clinical outcomes and mortality predictors in patients hospitalized in the pediatric intensive care unit due to sepsis. J Behcet Uz Child Hosp. 202515(2): 111-120.

https://www.doi.org/10.4274/jbuch.galenos.2025.03453.

12. Gündoğan BU, Dursun O, Tekerek NÜ, Dönmez L. Evaluation of the performance of PRISM III and PIM II scores in a tertiary pediatric intensive care unit. J Pediatr Emerg Intensive Care Med 2023; 10(1): 8-14. https://www.doi.org/10.4274/cayd.galenos.2022.48303

13. Ekinci F, Yildizdas D, Horoz OO, Arslan I, Ozkale Y, Yontem A et al. Performance and analysis of four pediatric mortality prediction scores among critically ill children: A multicenter prospective observational study in four PICUs. Arch Pédiatr. 2022 Aug 1 ; 29(6): 407-14. https://www.doi.org/10.1016/j.arcped.2022.05.001

14. Seifu A, Eshetu O, Tafesse D, Hailu S. Admission pattern, treatment outcomes, and associated factors for children admitted to pediatric intensive care unit of Tikur Anbessa specialized hospital, 2021: a retrospective cross-sectional study. BMC Anesthesiol. 2022 Jan 6; 22(1): 13-21. https://doi.org/10.1186/s12871-021-01556-7

15. Ebrahim MM, Mohamed AA, Mohammedamin MM. Predictors of survival in pediatric intensive care unit in a low-income country: A retrospective cohort study. Plos one. 2025 Feb 12; 20(2): e0315863. https://doi.org/10.1371/journal.pone.0315863

16. Teshager NW, Amare AT, Tamirat KS, Atalell KA, Genet GB. The Performance of Modified Pediatric Index of Mortality-2 Scoring System in a Pediatric Intensive Care Unit in Ethiopia. Ethiop J Health Biomed Sci. 2023 Mar 30; 13(1): 23-31.

https://doi.org/10.20372/ejhbs.v13i1.436

17. Sengupta D, Bhatt S, Patel S, Singh P. Comparative Evaluation of PRISM III, PIM 2, and PELOD Scores as Predictors of Outcome in Pediatric Intensive Care Unit Patients: An Experience From a Single Center in South Gujarat, India. Cureus. 2026 Feb 27; 18(2): 1-14.

https://www.doi.org/10.7759/cureus.104420.

18. Mazhar MB, Hamid MH. Validity of pediatric index of mortality 2 score as an outcome predictor in pediatric ICU of a public sector tertiary care hospital in Pakistan. J Pediatr Intensive Care 2022; 11(03): 226-232. https://www.doi.org/10.1055/s-0040-1722758

19. Agrwal S, Saxena R, Jha M, Jhamb U. Comparison of pSOFA with PRISM III and PIM 2 as predictors of outcome in a tertiary care pediatric ICU: a prospective cross-sectional study. Indian J Crit Care Med. 2024 Jul 31; 28(8): 796–801.

https://www.doi.org/10.5005/jp-journals-10071-24772