Performance of the Pediatric Index of Mortality 3 Score in PICUs in Argentina: A Prospective, National Multicenter Study

OBJECTIVE: To assess the performance of the Pediatric Index of Mortality 3 score in a population of children admitted to PICUs in Argentina. DESIGN: Prospective, national, multicenter study. SETTING: Forty-nine PICUs located in Argentina belonging to public and private institutions. PATIENTS: All children between 1 month and 16 years old admitted to the participating PICUs between May 15, 2016, and February 15, 2017. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: A total of 6,602 patients were enrolled in the study. The observed mortality was 8% (531/6,602), whereas mortality predicted by Pediatric Index of Mortality 3 was 6.16% (407 deaths). The standardized mortality rate was 1.3 (95% CI, 1.20–1.42). The area under the receiver operating characteristic curve was 0.83 (95% CI, 0.82–0.85). The Hosmer-Lemeshow test showed that the difference between the mortality observed and the mortality predicted by Pediatric Index of Mortality 3 was statistically significant (χ(2), 135.63; p < 0.001). CONCLUSIONS: The Pediatric Index of Mortality 3 score adequately discriminated patients who died from those who survived in our population. However, the observed mortality was higher than predicted by the score. The use of an updated instrument such as Pediatric Index of Mortality 3 will allow an actual comparison between pediatric intensive care provided in the country and care provided internationally. This might also allow future planning of pediatric intensive care services in Argentina.