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Paediatric Index of Mortality 3: An Updated Model for Predicting Mortality in Pediatric Intensive Care*

Straney, Lahn PhD1; Clements, Archie PhD2; Parslow, Roger C. BSc, MSc, PhD3; Pearson, Gale MBBS, MRCP, FRCPCH, Dip Math4; Shann, Frank MD, FRACP, FCICM5; Alexander, Jan6; Slater, Anthony FRACP, FCICM6,7

Pediatric Critical Care Medicine: September 2013 - Volume 14 - Issue 7 - p 673–681
doi: 10.1097/PCC.0b013e31829760cf
Feature Articles

Objectives: To provide an updated version of the Paediatric Index of Mortality 2 for assessing the risk of mortality among children admitted to an ICU.

Design: International, multicenter, prospective cohort study.

Setting: Sixty ICUs that accept pediatric admissions in Australia, New Zealand, Ireland, and the United Kingdom.

Patients: All children admitted in 2010 and 2011 younger than 18 years old at the time of admission and either died in ICU or were discharged. Patients who were transferred to another ICU were not included. Fifty-three thousand one hundred twelve patient admissions were included in the analysis.

Interventions: None.

Measurement and Main Results: A revised prediction model was built using logistic regression. Variable selection was based on significance at the 95% level and overall improvement of the model’s discriminatory performance and goodness of fit. The final model discriminated well (area under the curve, 0.88, 0.88–0.89); however, the model performed better in Australia and New Zealand than in the United Kingdom and Ireland (area under the curve was 0.91, 0.90–0.93 and 0.85, 0.84–0.86, respectively).

Conclusions: Paediatric Index of Mortality 3 provides an international standard based on a large contemporary dataset for the comparison of risk-adjusted mortality among children admitted to intensive care.

Supplemental Digital Content is available in the text.

1School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

2School of Population Health, The University of Queensland, Brisbane, QLD, Australia.

3Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, United Kingdom.

4Birmingham Children’s Hospital, Birmingham, United Kingdom.

5Royal Children’s Hospital, Melbourne, VIC, Australia.

6Australian and New Zealand Intensive Care Society, Brisbane, QLD, Australia.

7Royal Children’s Hospital, Brisbane, QLD, Australia.

* See also p. 718.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Dr. Parslow received grant support from the Department of Health (government grant - funds for data collection and analysis). Dr. Pearson served as the specialist advisor to the Care Quality Commission, is employed by the Birmingham Children's Hospital, provided expert testimony for Episodic and various sources, lectured for various entities, and received royalties from Elsevier. Dr. Alexander is employed by ANZPIC (registry manager). Dr. Slater is employed by the Royal Children's Hospital, Brisbane. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies