Development of a pediatric age- and disease-specific severity measure.
OBJECTIVE
To adapt the adult Comprehensive Severity Index (CSI) for hospitalized pediatric patients and evaluate the ability of the CSI to predict common outcomes.


METHODS
Adult CSI was modified by a panel of pediatric subspecialists from 10 children's hospitals. Predictive power was evaluated by using retrospective data collected from 16,495 randomly selected children admitted to these hospitals from April 1995 through September 1996. Outcomes were mortality, length of stay (LOS), and cost.


RESULTS
Admission CSI score predicted mortality well (Hosmer-Lemeshow tests: P =.41-.98) and discriminated well (area under receiver operating characteristic [ROC] curve range = 0.80-0.99) within 9 case-mix groups with > or =10 deaths (P <.0001). Maximum CSI score explained the variation in LOS (r2 = 0.13-0.67) and cost (r2 = 0.08-0.73) within 32 case-mix groups (P <.005). Significant differences existed in admission and maximum average CSI scores across sites in 26 and 29 of 32 case-mix groups, respectively (P <.05). CSI had better predictability than Pediatric Risk of Mortality.


CONCLUSIONS
The age- and disease-specific pediatric CSI score correlates highly with LOS, cost, and mortality in hospitalized children and can help determine the best clinical practices for specific diseases and adjust for differences in severity of illness across providers.
Horn
Susan D
SD
ISIS, Inc, the Institute for Clinical Outcomes Research, and the Department of Pediatrics, Primary Children's Medical Center, Salt Lake City, Utah 84109-1630, USA.
Torres
Adalberto
A
Willson
Douglas
D
Dean
J Michael
JM
Gassaway
Julie
J
Smout
Randall
R
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003953:Diagnosis-Related Groups; D004194:Disease / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000191:economics; D008297:Male; D010343:Patient Admission / Q000191:economics; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology