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Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units. Introdução à Medicina II 2011/2012 Class 12 1 Advisors: Rosa Oliveira 2 and Daniel Martins 3 1. [email protected]; 2. [email protected]; 3. [email protected]; .

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Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units

Introdução à Medicina II

2011/2012

Class 121

Advisors: Rosa Oliveira2andDaniel Martins3

1. [email protected];

2. [email protected];

3. [email protected];


Table of contents

  • Introduction Portuguese Pediatric Intensive Care Units

    • Contextualization

  • State of the Art

  • Background

    • Are scores discriminative? And calibrated?

    • Differences in calibration… Why?

    • Should scores be recalibrated?

    • Problems…

  • Research Questions

  • Aims

  • Methods

  • Expected results

  • Results

  • References

  • Acknowledgments

Table of Contents

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Introduction Portuguese Pediatric Intensive Care Units

Introduction

Introduction

State of the Art

State of the Art

Background

Background

  • Contextualization

  • A Pediatric Intensive Care Unit (PICU)is an area within a hospital specialized in the care of critically ill infants, children, and teenagers.

  • The type and number of patients and the provided health care differs according to its location.

Research Questions

Research Questions

Aims

Aims

Methods

Methods

Results

References

References

Acknowledgements

Acknowledgements

Frankel, Lorry R; DiCarlo, Joseph V (2003). “Pediatric Intensive Care”. In Bernstein, Daniel; Shelov, Steven P. Pediatrics for Medical Students (2nd ed.).

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units


Introduction Portuguese Pediatric Intensive Care Units

Introduction

Introduction

State of the Art

State of the Art

Portuguese PICUs

Background

Background

Research Questions

Research Questions

Consume human and financial resources

Aims

Aims

Methods

Methods

Results

Provide adequate treatment for severely ill children

References

References

Acknowledgements

Acknowledgements

PICUs – Pediatric Intensive Care Units

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units


Introduction Portuguese Pediatric Intensive Care Units

Introduction

Introduction

State of the Art

State of the Art

Portuguese PICUs

Background

Background

Research Questions

Research Questions

Provide adequate treatment for severely ill children

Aims

Aims

Major health quality resource

Pacient stratification

Methods

Methods

Evaluation

Results

References

References

Acknowledgements

Mortality rate

Assistance quality

Acknowledgements

PICUs – Pediatric Intensive Care Units

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units


Introduction Portuguese Pediatric Intensive Care Units

Introduction

Introduction

State of the Art

State of the Art

Portuguese PICUs

Background

Background

Research Questions

Research Questions

Provide adequate treatment for severely ill children

Aims

Aims

Major health quality resource

Pacient stratification

Methods

Methods

Evaluation

Results

References

References

Acknowledgements

Mortality rate

Assistance quality

Acknowledgements

PICUs – Pediatric Intensive Care Units

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units


Introduction Portuguese Pediatric Intensive Care Units

Introduction

Introduction

State of the Art

State of the Art

Portuguese PICUs

Background

Background

Research Questions

Research Questions

Provide adequate treatment for severely ill children

Aims

Aims

Major health quality resource

Pacient stratification

Methods

Methods

Evaluation

Results

References

References

Acknowledgements

Mortality rate

Assistance quality

Acknowledgements

PICUs – Pediatric Intensive Care Units

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units


Introduction Portuguese Pediatric Intensive Care Units

Introduction

Introduction

State of the Art

State of the Art

Portuguese PICUs

Background

Background

Research Questions

Research Questions

Provide adequate treatment for severely ill children

Aims

Aims

Major health quality resource

Pacient stratification

Methods

Methods

Evaluation

Results

References

References

Acknowledgements

Mortality rate

Assistance quality

Acknowledgements

PICUs – Pediatric Intensive Care Units

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units


Introduction Portuguese Pediatric Intensive Care Units

Introduction

Introduction

State of the Art

State of the Art

Portuguese PICUs

Background

Background

Research Questions

Research Questions

Provide adequate treatment for severely ill children

Aims

Aims

Major health quality resource

Pacient stratification

Methods

Methods

Evaluation

Results

References

References

Acknowledgements

Mortalit rate

Assistance quality

Acknowledgements

PICUs – Pediatric Intensive Care Units

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units


Introduction Portuguese Pediatric Intensive Care Units

Introduction

Introduction

State of the Art

State of the Art

Portuguese PICUs

Background

Background

Research Questions

Research Questions

Aims

Provide adequate treatment for severely ill children

Aims

Methods

Methods

Results

Consume human and financial resources

References

References

Acknowledgements

Acknowledgements

PICUs – Pediatric Intensive Care Units

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units


Introduction Portuguese Pediatric Intensive Care Units

Introduction

State of the Art

Background

Mortality Prognostic Scores

Research Questions

Aims

Methods

PIM

PRISM

Results

References

Acknowledgements

PIM – Pediatric Index of Mortality; PRISM – Pediatric Risk of Mortality

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units


Introduction Portuguese Pediatric Intensive Care Units

Introduction

State of the Art

Background

Mortality Prognostic Scores

Research Questions

Aims

Methods

PIM

PRISM

Results

References

Acknowledgements

PIM – Pediatric Index of Mortality; PRISM – Pediatric Risk of Mortality

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units


Introduction Portuguese Pediatric Intensive Care Units

Introduction

State of the Art

Background

Research Questions

Logit = (-4.873) + (values * Beta) + (0.021 * (absolute(SBP-120))) + (0.071 * (absolute base excess)) + (0.415 * (FiO2/PaO2))

Mortality Prediction Value= eLogit/ (1+eLogit)

Aims

Methods

Expected results

  • Amountofinformation;

  • Duration of theobservationperiod;

  • Momentinwhichtheinformationiscollected.1

References

PIM – Pediatric Index of Mortality; PRISM – Pediatric Risk of Mortality

Acknowledgements

1. Slater, A.M.B., FRACP, FJFICM; Shann, Frank MB, BS, MD, FRACP, FJFICM; the ANZICS Paediatric Study Group, The suitability of the Pediatric Index of Mortality (PIM), PIM2, the Pediatric Risk of Mortality (PRISM), and PRISM III for monitoring the quality of pediatric intensive care in Australia and New Zealand. Pediatric Critical Care Medicine, 2004. 5(5): p. 447-453.

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units

PICUs – Pediatric Intensive Care Units


State of the Art Portuguese Pediatric Intensive Care Units

Introduction

Introduction

State of the Art

State of the Art

Background

Background

Research Questions

Research Questions

Aims

Aims

Methods

Methods

Results

References

References

Acknowledgements

Acknowledgements

Carmen Ferández, J.L.-H., Jose C. Flores, Dolores Galaviz, Marta Rupérez, Kay B. Brandstrup, Amaya Bustinza, Prognosis in critically ill children requiring continuous renal replacement therapy. IPNA, 2005.

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Background Portuguese Pediatric Intensive Care Units

Introduction

Introduction

State of the Art

State of the Art

Are scores discriminative? And calibrated?

Background

Background

Research Questions

Research Questions

“Both PRISM and PIM scores have a good discriminatory performance. The calibration with PRISM score is good but the PIM score displays poor calibration.”

Aims

Aims

Methods

Methods

Results

References

References

Acknowledgements

Acknowledgements

PIM – Pediatric Index of Mortality; PRISM – Pediatric Risk of Mortality

Taori RN, L. K., Tullu MS (2010). "Performance of PRISM (Pediatric Risk of Mortality) score and PIM (Pediatric Index of Mortality) score in a tertiary care pediatric ICU." Indian J Pediatr 77(3): 267-271.

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Background Portuguese Pediatric Intensive Care Units

Introduction

Introduction

State of the Art

State of the Art

Diferences in calibration... Why?

Background

Background

Research Questions

Research Questions

Different regions

Aims

Aims

  • Population case-mix

  • Type of PICU

  • Admissionpolicy

Missing values

Methods

Methods

Recalibrations

Results

References

References

Acknowledgements

Acknowledgements

PICUs – Pediatric Intensive Care Units

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Background Portuguese Pediatric Intensive Care Units

Introduction

Introduction

State of the Art

State of the Art

Should scores be recalibrated?

Background

Background

“ In general, scoring systems should be used only in populations similar to the reference population in which the prediction model was developed.”1

Research Questions

Research Questions

Aims

Aims

“Subsequent validation of variables could improve the sensitivity and the value of severity scoring in the future. Nevertheless, illness severity scores will never be indicative of absolute irreversibility of disease or impossibility of survival...”2

Methods

Methods

Results

References

References

Acknowledgements

Wells M, R.-F.J., Luyt DK, Dance M, Lipman J., Poor discriminatory performance of the Pediatric Risk of Mortality (PRISM) score in a South African intensive care unit. Crit Care Med., 1996. 24(9)

Unertl K, K.B., Prognostic scores in intensive care. Anaesthesist., 1997. 46(6): p. 471-80.

Acknowledgements

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Background Portuguese Pediatric Intensive Care Units

Introduction

Introduction

State of the Art

State of the Art

Problems...

Background

Background

Research Questions

Research Questions

  • Inclusion and exclusion criteria of the data-base;

  • Time of collection;

  • Human resources;

  • Algorithm descalibration through time;

Aims

Aims

Methods

Methods

Results

References

References

Acknowledgements

Acknowledgements

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Background Portuguese Pediatric Intensive Care Units

Introduction

Recalibration

Introduction

PIM-2

PIM

State of the Art

PIM-3

State of the Art

PRISM III

PRISM

Background

Background

Background

Assessment and Optimization of Mortality Pronostic Scores in Portuguese Pediatric Intensive Care

“Are they doing a good job?”

MARTINS, D. A. A. 1; SANTOS, L. R.1; FIGUEIREDO, M. A. R. M.1; GUERRA, M. D. L.1; MAGALHÃES, R. S.1; FRANCISCO, R. M. H.1; REBELO, C. A. B. S. T.1; ABREU, C. A. M. L. M.1; LAIGINHAS, A. R. A.1; DIAS, M. O.1; CHAVES, J. G. A. C.1; OLIVEIRA, R. C. S.1,2;

Aim: To evaluate the Pediatric Risk of Mortality (…) and the Pediatric Index of Mortality (…) performance at Portuguese Pediatric Intensive Care Units, where PIM2-R is the recalibrated PIM2 model using the Australia and New Zealand Pediatric Intensive Care 2008 coefficients (which is for the first time applied and analyzed in Portuguese context).

Research Questions

Research Questions

Aims

Aims

Lack of calibration and discrimination in Portuguese reality

Methods

Methods

Results

References

References

Acknowledgements

Acknowledgements

PIM – Pediatric Index of Mortality; PRISM – Pediatric Risk of Mortality

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Expected results Portuguese Pediatric Intensive Care Units

Introduction

State of the Art

PIM AND PRISM underestimated the risk of death in other realities

Background

We expect...

Research Questions

Underestimated risk of death in Portugal

Aims

We look forward to...

Methods

Results

Optimize of the quality of the health care provided

References

Acknowledgements

PIM – Pediatric Index of Mortality; PRISM – Pediatric Risk of Mortality

CarmenFerández, J.L.-H., Jose C. Flores, Dolores Galaviz, Marta Rupérez, Kay B. Brandstrup, AmayaBustinza, Prognosis in critically ill children requiringcontinuous renal replacementtherapy. IPNA, 2005.

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Research Questions Portuguese Pediatric Intensive Care Units

Introduction

Introduction

State of the Art

State of the Art

Background

Background

  • How do Pediatric Mortality Prognostic Scores (PIM-2) behave in Portuguese PICUs’ specific groups of diagnosis?

  • Is it possible to enhance the performance of PIM-2 with a new recalibration?

  • With what purpose are scores used in Portuguese PICUs’?

Research Questions

Research Questions

Aims

Aims

Methods

Methods

Results

References

References

Acknowledgements

Acknowledgements

PICUs – Pediatric Intensive CareUnits; PIM – PediatricIndexofMortality

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Specific Portuguese Pediatric Intensive Care Unitsaims

Introduction

Introduction

State of the Art

State of the Art

  • To assess calibration and discrimination of Pediatric Mortality Prognostic Scores in Portuguese PICUs and in the specific diagnosis groups.

  • To recalibratePIM-2, in the broad-spectrum patients and to specific diagnosis group.

  • To evaluate the new model concerning calibration and discrimination

  • To understand clinicians awareness ofthe purpose and use ofprognostic mortality scores in Portuguese PICUs.

Background

Background

Research Questions

Research Questions

Aims

Aims

Methods

Methods

Results

References

References

Acknowledgements

Acknowledgements

PICUs – Pediatric Intensive CareUnits; PIM – PediatricIndexofMortality

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Methods Portuguese Pediatric Intensive Care Units

Introduction

Introduction

Target Population

State of the Art

State of the Art

Background

Background

Research Questions

Research Questions

The target population will be all children admitted in Portuguese PICUs.

Aims

Aims

Methods

Methods

Results

References

References

Acknowledgements

Acknowledgements

PICUs – Pediatric Intensive CareUnits

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units

23


Methods Portuguese Pediatric Intensive Care Units

Introduction

Introduction

Sample

State of the Art

State of the Art

Background

Sources: PICUs from Hospital de Santa Maria, Hospital de D. Estefânia, Hospital Fernando da Fonseca, Hospital Geral de S. João, Hospital Pediátrico de Coimbra, Hospital Garcia de Orta, Hospital Geral de Santo António, Hospital da Misericórdia de Paredes and Hospital de Faro.

Background

Research Questions

Research Questions

Aims

Aims

Methods

Methods

Results

Children wereincludedin different groups of diagnosis.

References

References

Acknowledgements

Acknowledgements

PICUs – Pediatric Intensive Care Units

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Methods Portuguese Pediatric Intensive Care Units

Introduction

Introduction

Sample

State of the Art

State of the Art

Background

Age(mean):

2005-2006: 6 y 1 m;

2007-2008: 6 y 1 m.

Lenghtof stay(mean):

2005-2006: 182h;

2007-2008: 127h.

Background

Research Questions

Research Questions

Aims

Aims

Methods

Methods

Results

References

References

Acknowledgements

Acknowledgements

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Methods Portuguese Pediatric Intensive Care Units

Introduction

Introduction

Sample

State of the Art

State of the Art

Background

Background

Research Questions

Research Questions

Aims

Aims

Methods

Methods

Results

References

References

Acknowledgements

Acknowledgements

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Methods Portuguese Pediatric Intensive Care Units

Introduction

Introduction

Validation

State of the Art

State of the Art

Background

Standardized Mortality Ratio (SMR)

Calibration

Discrimination

Background

Research Questions

Research Questions

Aims

Aims

Methods

Methods

Results

References

References

Acknowledgements

Acknowledgements

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Methods Portuguese Pediatric Intensive Care Units

Introduction

Introduction

Validation

State of the Art

State of the Art

Background

Standardized Mortality Ratio (SMR)

Calibration

Discrimination

Background

Research Questions

Research Questions

Observed deaths / expected deaths

Aims

Aims

Methods

Methods

Results

References

References

Acknowledgements

Acknowledgements

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Methods Portuguese Pediatric Intensive Care Units

Introduction

Introduction

Validation

State of the Art

State of the Art

Background

Standardized Mortality Ratio (SMR)

Calibration

Discrimination

Background

Research Questions

Research Questions

Hosmer-Lemeshow Test

Aims

Aims

Methods

Methods

Results

References

References

Acknowledgements

Acknowledgements

Case-mix and Optimization in Mortality Prognostic Scores in Portuguese PICUs

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Methods Portuguese Pediatric Intensive Care Units

Introduction

Introduction

Validation

State of the Art

State of the Art

Background

Standardized Mortality Ratio (SMR)

Calibration

Discrimination

Background

Research Questions

Research Questions

Relative Operating Characteristic (ROC) Curves

Aims

Aims

Methods

Methods

Results

Sensitivity vs.

1-Specificityfor every value of the score

References

References

Acknowledgements

Acknowledgements

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Methods Portuguese Pediatric Intensive Care Units

Introduction

Introduction

State of the Art

State of the Art

Validation

Background

Background

Standardized Mortality Ratio

Calibration

Discrimination

Research Questions

Research Questions

Aims

Relative Operating Characteristic (ROC) Curves

Aims

Methods

Methods

Results

References

Sensitivity vs.

1-Specificityfor every value of the score

References

Area under the (AUC)

ROC Curve

Acknowledgements

Acknowledgements

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Methods Portuguese Pediatric Intensive Care Units

Introduction

State of the Art

State of the Art

Background

Background

Research Questions

Research Questions

Aims

Aims

Methods

Methods

Results

References

References

Acknowledgements

Acknowledgements

AUC – Area Under the ROC Curve

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Methods Portuguese Pediatric Intensive Care Units

Introduction

State of the Art

Background

Surveys of use

Research Questions

Main study

Aims

Methods

Results

Grounding of conclusions

References

Acknowledgements

https://docs.google.com/spreadsheet/viewform?pli=1&formkey=dHZpbU9hX1h6cFEyWExnTzNzRHplcnc6MQ#gid=0

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units

33


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

Background

Research Questions

Aims

Methods

Results

References

Acknowledgements

*1 - Total disagreement, …, 5 - Total agreement


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

Background

Research Questions

Aims

Methods

Results

References

Acknowledgements

*1 - Total disagreement, …, 5 - Total agreement


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

Background

Research Questions

Aims

Methods

Results

References

Acknowledgements

*1 - Total disagreement, …, 5 - Total agreement


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

Background

Research Questions

Aims

Methods

Results

References

Acknowledgements

*1 - Total disagreement, …, 5 - Total agreement


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

Background

Research Questions

Aims

Methods

Results

References

Acknowledgements


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

Background

Research Questions

Aims

Methods

Results

References

Acknowledgements


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

Background

Research Questions

Sensitivity

Aims

2005/2006

Methods

Results

References

1-Specificity

Acknowledgements

AUC – Area Under the Curve; PIM – Pediatric Index ofMortality


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

Background

Research Questions

Sensitivity

Aims

2007/2008

Methods

Results

References

1-Specificity

Acknowledgements

AUC – Area Under the Curve; PIM – Pediatric Index ofMortality


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

Background

Research Questions

Aims

Methods

Results

References

Acknowledgements


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

Background

Research Questions

Aims

Methods

Results

References

Acknowledgements


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

Background

Research Questions

Aims

Methods

Results

References

Acknowledgements


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

Background

Research Questions

Aims

Methods

Results

References

Acknowledgements

AUC – Area Under the Curve; PIM – Pediatric Index ofMortality


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

Background

Research Questions

Aims

Methods

Results

References

Acknowledgements

AUC – Area Under the Curve; PIM – Pediatric Index ofMortality


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

Background

Research Questions

Aims

Methods

Results

References

Acknowledgements

AUC – Area Under the Curve; PIM – Pediatric Index ofMortality


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

  • New Algorithm:

    • PIM-2 IM=(-0.015 x SBP)+(4.270 x PUPIL REACTION)+ - 0.011 x mm)+(0.040 x BASE EXCESS)+(- 0.695 x VENTILATION)+(- 3.019 x PLANED ADMISSION)+(-1.099 x POST OPERATORY)+(19.805 x CARDIAC SURGERY)+(0.702 x RECOVERY)+(0.426 x DIGESTIVE) + 2.779

Background

Research Questions

Aims

Methods

Results

References

Acknowledgements


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

2007/2008

Background

Sensitivity

Research Questions

Aims

1-Specificity

Methods

Results

References

Acknowledgements

AUC – Area Under the Curve; PIM – Pediatric Index ofMortality


Introduction Portuguese Pediatric Intensive Care Units

Results

State of the Art

Background

Research Questions

Aims

Methods

Results

References

Acknowledgements


Introduction Portuguese Pediatric Intensive Care Units

Results

PIM-2 IM

State of the Art

Background

Research Questions

Aims

Methods

PIM-2 2006

Results

References

Acknowledgements


Introduction Portuguese Pediatric Intensive Care Units

Results

PIM-2 IM

State of the Art

Background

Research Questions

Aims

Methods

PIM-2 2006

Results

References

Acknowledgements


Introduction Portuguese Pediatric Intensive Care Units

Conclusions and Discussion

State of the Art

Background

  • PIM-2 showed acceptable discrimination but poor calibration in specific diagnosis groups and in general Portuguese PICUs.

  • Recalibrated version of PIM-2 showed better discrimination and calibration either in specific diagnosis groups either general Portuguese PICUs than the ones used nowadays.

  • Mortality Prognostic Scores’ importance is recognized in Portuguese PICUs, however:

    • Clinicians don’t feel the need of a recalibration

    • Scores don’t frequently lead to a change in clinical practice.

Research Questions

Aims

Methods

Results

References

Acknowledgements


Introduction Portuguese Pediatric Intensive Care Units

Conclusions and Discussion

State of the Art

Background

  • PIM-2 showed acceptable discrimination but poor calibration in specific diagnosis groups and in general Portuguese PICUs.

  • Recalibrated version of PIM-2 showed better discrimination and calibration either in specific diagnosis groups either general Portuguese PICUs than the ones used nowadays.

  • Mortality Prognostic Scores’ importance is recognized in Portuguese PICUs, however:

    • Clinicians don’t feel the need of a recalibration

    • Scores don’t frequently lead to a change in clinical practice.

Research Questions

Aims

Methods

Results

References

Acknowledgements


Introduction Portuguese Pediatric Intensive Care Units

Conclusions and Discussion

State of the Art

Background

  • PIM-2 showed acceptable discrimination but poor calibration in specific diagnosis groups, and in general Portuguese PICUs.

  • Recalibrated version of PIM-2 showed better discrimination and calibration either in specific diagnosis groups and general Portuguese PICUs than the ones used nowadays.

  • Mortality Prognostic Scores’ importance is recognized in Portuguese PICUs, however:

    • Clinicians don’t feel the need of a recalibration

    • Scores don’t frequently lead to a change in clinical practice.

Research Questions

Aims

Methods

Results

References

Acknowledgements


References Portuguese Pediatric Intensive Care Units

Introduction

State of the Art

  • Anthony R. Brady, D.H., Stephanie Black, Sam Jones, Kathy Rowan, Gale Pearson, Jane Ratcliffe and Gareth J. Parry, Assessment and Optimization of Mortality Prediction Tools for Admissions to Pediatric Intensive Care in the United Kingdom. Pediatrics, 2006. 117;

  • Carmen Ferández, J.L.-H., Jose C. Flores, Dolores Galaviz, Marta Rupérez, Kay B. Brandstrup, Amaya Bustinza, Prognosis in critically ill children requiring continuous renal replacement therapy. IPNA, 2005;

  • César Sánchez, J.L.-H., Santiago Mencía, Javier Urbano, Angel Carrillo and José MaríaBellón, Clinical severity scores do not predict tolerance to enteral nutrition in critically ill children. British Journal of Nutrition, 2009. 102: p. 191–194;

  • EsraArunOzer, A.K., BerrakSarioglu, OyaHalicioglu, Sumer Sutcuoglu, and IsinYaprak, The Comparison of PRISM and PIM Scoring Systems for Mortality Risk in Infantile Intensive Care. Journal of Tropical Pediatrics, 2004. 50;

Background

Research Questions

Aims

Methods

Results

References

Acknowledgements

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


References Portuguese Pediatric Intensive Care Units

Introduction

State of the Art

  • Ganapathy Balakrishnan, T.A., David Hallworth, Neil S Morton, Prospective evaluation of the Paediatric Risk of Mortality (PRISM) score. Archives ofDisease in Childhood, 1992. 67: p. 196-200.

  • Okay, G.A.C.A.F.D.A.F.T.S., Application of the pediatric risk of mortality (PRISM) score and determination of mortality risk factors in a tertiary pediatric intensive care unit. Clinics, 2010. 65.

  • Pollack MM, R.U., Getson PR, Pediatric risk of mortality (PRISM) score. Crit Care Med, 1998. 16(11): p. 1110-6.

  • Slater, A.M.B., FRACP, FJFICM; Shann, Frank MB, BS, MD, FRACP, FJFICM; the ANZICS Paediatric Study Group, The suitability of the Pediatric Index of Mortality (PIM), PIM2, the Pediatric Risk of Mortality (PRISM), and PRISM III for monitoring the quality of pediatric intensive care in Australia and New Zealand. Pediatric Critical Care Medicine, 2004. 5(5): p. 447-453.

  • S. Prieto Espuñes, J.L.-H.C., C. Rey Galán, A. Medina Villanueva, A. Concha Torre y P. Martínez Camblor, Índices pronósticos de mortalidad en cuidados intensivos pediátricos. An Pediatr (Barc), 2007. 66: p. 345-50.

Background

Research Questions

Aims

Methods

Expected results

References

Acknowledgements

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


References Portuguese Pediatric Intensive Care Units

Introduction

  • S M Tibby, D.T., M Festa, S Hanna, M Hatherill, G Jones, P Habibi, A Durward, I A Murdoch, A comparison of three scoring systems for mortality risk among retrieved intensive care patients. Arch Dis Child, 2002. 87: p. 421-425;

  • Vanessa Feller Martha, P.C.R.G., Jefferson Pedro Piva, Paulo Roberto Einloft, Francisco Bruno, Viviane Rampon, Comparação entre dois escores de prognóstico (PRISM e PIM) em unidade de terapia intensiva pediátrica. Jornal de Pediatria, 2005. 81(3): p. 259-64.

State of the Art

Background

Research Questions

Aims

Methods

Expected results

References

Acknowledgements

Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units


Acknowledgments Portuguese Pediatric Intensive Care Units

Introduction

State of the Art

  • We gratefully acknowledge :

  • Professor Altamiro Costa Pereira;

  • PhdArmando Teixeira-Pinto;

  • Msc Rosa Oliveira;

  • Daniel Martins;

  • for their guidance and time

    • And you;

  • For your attention.

  • Background

    Research Questions

    Aims

    Methods

    Expected results

    References

    Acknowledgements

    Case-mix and Optimization of Mortality Prognostic Scores in Portuguese Pediatric Intensive Care Units

    PICUs – Pediatric Intensive Care Units


    The Portuguese Pediatric Intensive Care UnitsEnd

    Questions?

    Introdução à Medicina II

    2011/2012

    Class 121

    Advisors: Rosa Oliveira2andDaniel Martins3

    1. [email protected];

    2. [email protected];

    3. [email protected];


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