ArticleActa paediatrica (Oslo, Norway : 1992)2026
Paediatric Index of Mortality 3 in Sweden: Validation and Recalibration to Improve Mortality Prediction in Paediatric Intensive Care.
Article in Acta paediatrica (Oslo, Norway : 1992), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimIn Sweden, critically ill children are admitted to one of four dedicated paediatric intensive care units (PICUs) or general intensive care units (ICUs), reflecting a partly centralised system. The Paediatric Index of Mortality 3 (PIM3) is a widely used risk stratification tool for predicting mortality in critically ill children. This study aimed to validate PIM3 in a national Swedish cohort, recalibrate the model where indicated and compare outcomes between PICUs and ICUs.
methodsThis retrospective cohort study used prospectively collected data from the Swedish Intensive Care Registry of admissions reported between 1 January 2016 and 30 September 2022. Discrimination and calibration were assessed, and recalibration was performed using logistic regression.
results19 183 admissions were included, 10 714 males and 8469 females. Prior to recalibration, PIM3 overestimated mortality in both settings, with standardised mortality rates (SMRs) of 0.72 (95% Confidence Interval (CI) 0.64-0.80) in PICUs and 0.52 (95% CI 0.42-0.63) in ICUs. Following recalibration, SMR was 0.92 (95% CI 0.70-1.20) and 0.96 (95% CI 0.59-1.49) in PICUs and ICUs, respectively.
conclusionPIM3 demonstrated excellent discrimination but systematically overestimated mortality in the Swedish context. Recalibration corrected this bias and attenuated outcome differences between PICU and ICU settings.
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