There is a lack of broadly applicable measures for risk adjustment in pediatric surgical patients necessary for improving outcomes and patient safety. Our objective was to develop a risk stratification model that predicts mortality after surgical operations in children.


The model was created by using inpatient databases from 1988 to 2006. Patients younger than 18 years who underwent an inpatient surgical procedure as identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification, coding were included. A 7-point scale was developed with 70 variables selected for their predictive value for mortality using multivariate analysis. This model was evaluated with receiver operating characteristic (ROC) analysis and compared with the Charlson Comorbidity Index (CCI) in two separate validation data sets.


A total of 2 087 915 patients were identified in the training data set. Generated risk scores positively correlated with inpatient mortality. In the training data set, the ROC was 0.949 (95% confidence interval [CI]: 0.947, 0.950). In the first validation data set, the ROC was 0.959 (95% CI: 0.952, 0.967) compared with the CCI ROC of 0.596 (95% CI: 0.575, 0.616). In the second validation data set, the ROC was 0.901 (95% CI: 0.885, 0.917) and the CCI ROC was 0.587 (95% CI: 0.562, 0.611).


This study depicts creation of a broadly applicable model for risk adjustment that predicts inpatient mortality with more reliability than current risk indexes in pediatric surgical patients. This risk index will allow comorbidity-adjusted outcomes broadly in pediatric surgery.

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