9% vs. 5.6%, p = 0.5). The score discrimination assessed by the area under the ROC curve was considered adequate both in the general population and in the subgroups of patients with and without CCC (Table 2). The score calibration assessed by the Hosmer-Lemeshow goodness-of-fit test was considered inadequate in the general population and in the subgroup of patients with CCC, but it was considered appropriate in the subgroup of patients without CCC (Table 2). The PIM2 score was chosen for evaluation, as it

is considered to be user-friendly and efficient, and it is public domain.10 The PIM2 is the updated version of the Pediatric Index of Mortality that was published in 1997, and has been used extensively since then.11 and 12 Since its publication in 2003, several studies have been published evaluating the score performance in populations and scenarios that were different Selleck ZVADFMK from those used in the score development study, with most studies showing

adequate score performance.10 In the present study, 83.9% selleck inhibitor of patients admitted to the PICU had one CCC, higher values than those found in a recent study that found a prevalence of 53% in a cohort that included patients from 54 PICUs in the United States.2 The high proportion of patients with CCCs that was observed in the present study and in the recent literature may be related to advances in medical care in recent years, especially in pediatric and neonatal intensive care, which have resulted in improvement in survival rates of patients with previously unmanageable diseases, leading to an increase of patients with CCCs, who have higher risk of hospitalization enough in the PICU than the general population.13 and 14 The overall mortality of the study population was 9.7%, consistent with the currently observed rates in the PICUs, which

range from 5-10%.15 There was a trend toward higher mortality in patients with CCCs, when compared with patients without CCCs, but without statistical significance. The observation that patients with chronic diseases have higher mortality rates when admitted to the PICU has been reported in recent literature. Wölfler et al., in a study evaluating the PIM2, observed a high mortality in patients with chronic diseases compared with the general population (15.6% vs. 5.2%). 16 Odetola et al. observed a significantly higher mortality in patients with comorbidities when compared to patients without comorbidities admitted to the PICUs in the United States in 1997 (12.5% vs. 8.6%) and in 2006 (10.8% vs. 7.8%). 17 Edwards et al. also observed a higher mortality rate among patients with CCCs, when compared to patients without CCCs admitted to PICUs in the United States in 2008 (3.9% vs. 2.2%). 2 However, this trend of increased mortality in patients with CCCs in the present study was not verified by the probability of death estimated by PIM2, which was similar in patients with and without CCCs (5.9% vs. 5.6%, p = 0.5) and may indicate poor score performance.