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Scoring systems for ICU and surgical patients:

PIM 2 (Paediatric Index of Mortality) 

Reference

• A. Slater et al. PIM 2 : a revised version of the Paediatric Index of Mortality. Intensive Care Med 2003 ;29:278-85.

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PIM2 is calculated from the information collected at the time a child is admitted to your ICU. Because PIM2 describes how ill the child was at the time you started intensive care, the observations to be recorded are those made at or about the time of first face-to-face (not telephone) contact between the patient and a doctor from your intensive care unit (or a doctor from a specialist paediatric transport team). Use the first value of each variable measured within the period from the time of first contact to 1 h after arrival in your ICU. The first contact may be in your ICU, your emergency department, a ward in your own hospital, or in another hospital (e.g.on a retrieval). If information is missing (e.g. Base Excess is not measured) record zero, except for systolic blood pressure, which should be recorded as 120. Include all children admitted to your ICU (consecutive admissions).

1. Systolic blood pressure, mmHg (unknown=120)¹
2. Pupillary reactions to bright light (>3 mm and both fixed=1, other or unknown=0)²
3. PaO2, mmHg (unknown=0), FIO2 at the time of PaO2 if oxygen via ETT or headbox (unknown=0)
4. Base Excess in arterial or capillary blood, mmol/l (unknown=0)
5. Mechanical ventilation at any time during the first hour in ICU (no=0, yes=1)³
6. Elective admission to ICU (no=0, yes=1)⁴
7. Recovery from surgery or a procedure is the main reason for ICU admission (no=0,yes=1)⁵
8. Admitted following cardiac bypass (no=0, yes=1)⁶
9. High risk diagnosis. Record the number in brackets. If in doubt record 0.

[0] None
[1] Cardiac arrest preceding ICU admission ⁷
[2] Severe combined immune deficiency
[3] Leukaemia or lymphoma after first induction
[4] Spontaneous cerebral haemorrhage ⁸
[5] Cardiomyopathy or myocarditis
[6] Hypoplastic left heart syndrome ⁹
[7] HIV infection
[8] Liver failure is the main reason for ICU admission ¹⁰
[9] Neuro-degenerative disorder ¹¹

10. Low risk diagnosis. Record the number in brackets. If in doubt record 0.

[0] None
[1] Asthma is the main reason for ICU admission
[2] Bronchiolitis is the main reason for ICU admission ¹²
[3] Croup is the main reason for ICU admission
[4] Obstructive sleep apnoea is the main reason for ICU admission ¹³
[5] Diabetic keto-acidosis is the main reason for ICU admission

 

Coding rules. These rules must be followed carefully for PIM2 to perform reliably :

1. Record SBP as 0 if the patient is in cardiac arrest, record 30 if the patient is shocked and the blood pressure is so low that it cannot be measured.

2. Pupillary reactions to bright light are used as an index of brain function. Do not record an abnormal finding if this is due to drugs, toxins or local eye injury.

3. Mechanical ventilation includes mask or nasal CPAP or BiPAP or negative pressure ventilation.

4. Elective admission.Include admission after elective surgery or admission for an elective procedure (e.g. insertion of a central line), or elective monitoring, or review of home ventilation. An ICU admission or an operation is considered elective if it could be post poned for more than 6 h without adverse effect.

5. Recovery from surgery or procedure includes a radiology procedure or cardiac catheter. Do not include patients admitted from the operating theatre where recovery from surgery is not the main reason for ICU admission (e.g.a patient with a head injury who is admitted from theatre after insertion of an ICP monitor; in this patient the main reason for ICU admission is the head injury).

6. Cardiac bypass. These patients must also be coded as recovery from surgery.

7. Cardiac arrest preceding ICU admission includes both in-hospital and out-of-hospital arrests. Requires either documented absent pulse or the requirement for external cardiac compression. Do not include past history of cardiac arrest.

8. Cerebral haemorrhage must be spontaneous (e.g. from aneurysm or AV malformation). Do not include traumatic cerebral haemorrhage or intracranial haemorrhage that is not intracerebral (e.g.subdural haemorrhage).

9. Hypoplastic left heart syndrome. Any age, but include only cases where a Norwood procedure or equivalent is or was required in the neonatal period to sustain life.

10. Liver failure acute or chronic must be the main reason for ICU admission.Include patients admitted for recovery following liver transplantation for acute or chronic liver failure.

11. Neuro-degenerative disorder. Requires a history of progressive loss of milestones or a diagnosis where this will inevitably occur.

12. Bronchiolitis. Include children who present either with respiratory distress or central apnoea where the clinical diagnosis is bronchiolitis.

13. Obstructive sleep apnoea. Include patients admitted following adenoidectomy and/or tonsillectomy in whom obstructive sleep apnoea is the main reason for ICU admission (and code as recovery from surgery).

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