ObjectiveComparative assessment of pediatric intensive care.DesignProspective multicenter study.SettingFour pediatric intensive care units in Moscow, the Russian Federation.PatientsConsecutive unselected admissions (n = 583), <or=to14 yrs of age, in a 6-month period.InterventionsNone.Measurements and Main Results1% or the administration of intensive care unit-dependent therapies. In all four hospitals, observed mortality rates were higher than expected, with a range of standardized mortality ratios between 1.10 and 1.83 (mean 1.32). The excess mortality was found in the low- and medium-risk strata (risk of mortality of <1% to 15%). Admission efficiency ratings did not fluctuate greatly between institutions (mean 60.4%, range 55.7 to 65.9).ConclusionsWe provided a quantitative description and assessment of pediatric intensive care in Moscow. Moderate efficiency may reflect a low threshold for ICU admission due to poor nurse/patient ratios on the wards. Effectiveness in the low- and medium-risk strata is below standard, as compared with a Western reference population. Excess mortality was concentrated in the low- and medium-risk strata, and can only partially be explained by the inclusion of co-morbidity. Future analysis should focus on specific treatment protocols, protocol adherence, and the determination of infectious and therapeutic complications.(Crit Care Med 1996; 24:1403-1407)