title: The Importance of Mortality Risk Assessment: Validation of the Pediatric Index of Mortality 3 Score.
abstract: OBJECTIVE
  To evaluate the performance of the newest version of the Pediatric Index of Mortality 3 score and compare it with the Pediatric Index of Mortality 2 in a multicenter national cohort of children admitted to PICU.
  
  
  METHODS
  Retrospective, prospective cohort study.
  
  
  METHODS
  Seventeen Italian PICUs.
  
  
  METHODS
  All children 0 to 15 years old admitted in PICU from January 2010 to October 2014.
  
  
  METHODS
  None.
  
  
  RESULTS
  Eleven thousand one hundred nine children were enrolled in the study. The mean Pediatric Index of Mortality 2 and 3 values of 4.9 and 3.9, respectively, differed significantly (p < 0.05). Overall mortality rate was 3.9%, and the standardized mortality ratio was 0.80 for Pediatric Index of Mortality 2 and 0.98 for Pediatric Index of Mortality 3 (p < 0.05). The area under the curve of the receiver operating characteristic curves was similar for Pediatric Index of Mortality 2 and Pediatric Index of Mortality 3. The Hosmer-Lemeshow test was not significant for Pediatric Index of Mortality 3 (p = 0.21) but was highly significant for Pediatric Index of Mortality 2 (p < 0.001), which overestimated death mainly in high-risk categories.
  
  
  CONCLUSIONS
  Mortality indices require validation in each country where it is used. The new Pediatric Index of Mortality 3 score performed well in an Italian population. Both calibration and discrimination were appropriate, and the score more accurately predicted the mortality risk than Pediatric Index of Mortality 2.
authors.affiliation: 1Department of Anesthesia and Intensive Care, Children's Hospital V Buzzi, University of Milan, Milan, Italy. 2Department of Pediatrics, Ospedale, Ospedale Maggiore della Carità, Novara, Italy. 3Department of Anesthesia and Intensive Care, Children's Hospital Sant'Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. 4Department of Anesthesia and Intensive Care, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy. 5Department of Pediatric Anesthesia and Intensive Care, Spedali Civili, Brescia, Italy. 6Department of Neonatal and Paediatric Intensive Care, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 7Pediatric ICU, Department of Woman's and Child's Health, University Hospital, Padova, Italy. 8Department of Anesthesia and Intensive Care, Institute for Maternal and Child health, IRCCS Burlo Garofolo, Trieste, Italy. 9Department of Pediatric Anesthesia and Intensive Care, Ospedale Sant'Orsola Malpighi, Bologna, Italy. 10Department of Anesthesia and Intensive Care, Children's Hospital Bambino Gesù, Rome, Italy. 11Pediatric ICU, Anesthesia and Intensive Care Department, Policlinico Universitario A.Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. 12Department of Anesthesia and Intensive Care, Children's Hospital Santobono-Pausilipon, Napoli, Italy. 13Department of Anesthesia and Intensive Care, Children's Hospital G Di Cristina, Palermo, Italy. 14Department of Pediatric Anesthesia and Intensive Care, Ospedale Garibaldi Nesima, Catania, Italy. 15Pediatric ICU, Pediatric Department, University of Messina, Messina, Italy. 16Health Care Systems Department, CINECA-Interuniversity Consortium, Bologna, Italy. 17Epidemiology and Biostatistics Units, Institute of Biomedical Technologies-National Research Council, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Wolfler
authors.forename: Raffaella
authors.initials: R
authors.lastname: Osello
authors.forename: Jenny
authors.initials: J
authors.lastname: Gualino
authors.forename: Edoardo
authors.initials: E
authors.lastname: Calderini
authors.forename: Gianluca
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authors.lastname: Vigna
authors.forename: Pierantonio
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authors.forename: Angela
authors.initials: A
authors.lastname: Amigoni
authors.forename: Fabio
authors.initials: F
authors.lastname: Savron
authors.forename: Fabio
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authors.lastname: Caramelli
authors.forename: Emanuele
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authors.forename: Corrado
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authors.lastname: Cecchetti
authors.forename: Maurizio
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authors.forename: Marco
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authors.forename: Raffaele
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authors.forename: Giancarlo
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authors.forename: Giusi
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authors.lastname: Stancanelli
authors.forename: Eloisa
authors.initials: E
authors.lastname: Gitto
authors.forename: Roberta
authors.initials: R
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authors.forename: Federica
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mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006305:Health Status Indicators; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007558:Italy; D012372:ROC Curve; D020379:Risk Adjustment; D018570:Risk Assessment