Severity and case-mix adjustment methodologies in pediat-ric critical care have not only spawned many quality assessments by comparing observed with predicted outcomes, but they have themselves become the focus on many evaluations. The two general pediatric severity of illness systems, the Pediatric Risk of Mortality and the Pediatric Index of Mortality (PIM), have published their validation data and have undergone intermittent adjustments and revalidations, which may or may not be in the public domain (1, 2).
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