Key result
Recalibration of the Paediatric Index of Mortality 3 corrected its systematic overestimation of mortality in Swedish ICUs, improving the standardised mortality rate in PICUs from 0.72 to 0.92.
Why the study?
In Sweden's partly centralised system, critically ill children are admitted to dedicated PICUs or general ICUs, and validation and recalibration of the PIM3 risk stratification tool were needed.
Does recalibration of the Paediatric Index of Mortality 3 (PIM3) improve mortality prediction in critically ill children in Sweden?
Cohort (n=19,183)
Yes
Does recalibration of the Paediatric Index of Mortality 3 (PIM3) improve mortality prediction in critically ill children in Sweden?
The PIM3 score systematically overestimates mortality in Swedish pediatric intensive care settings, but recalibration corrects this bias and improves prediction accuracy.
Answers are grounded in this paper and cite their sources.
Warrants PIM3 recalibration before benchmarking in pediatric ICUs; leaves open effects on risk-adjusted outcomes research.
AIM: In 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. METHODS: This 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. RESULTS: 19 183 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. CONCLUSION: PIM3 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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Engerström et al. (2026) conducted a cohort in Critically ill children (n=19,183). Paediatric Index of Mortality 3 (PIM3) recalibration vs. Original PIM3 model was evaluated on Standardised mortality rate (SMR) (95% CI 0.70-1.20). Recalibration of the Paediatric Index of Mortality 3 corrected its systematic overestimation of mortality in Swedish ICUs, improving the standardised mortality rate in PICUs from 0.72 to 0.92.
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