Conclusions

    This study reinforces the idea that risk-adjustment methods that are developed primarily in other countries require validation before being used to provide risk-adjusted outcomes of PICU mortality for units within a new health care setting. It is also important that the calibration of these tools be reassessed periodically to ensure their continued validity.

    The identification of suitable risk-adjustment tools is only a first step. It now is important that they be applied effectively to monitor outcome and to improve the quality of pediatric intensive care within Portugal.