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The lead author, JMN, has had a contract from the Children's Hospital Association to contribute to the development of software from 3M Health Information Systems. One of these, CRGs, is used in this study. He also has a no cost research license from 3M Health Information Systems to use CRGs. He has no financial interests in the Children's Hospital Association or 3M Health Information Systems, and receives no royalty revenue from these organizations. Neither the Children's Hospital Association nor 3M Health Information Systems have had any input to this study and have not reviewed the results or the manuscript prior to submission. The other authors declare that they have no conflict of interest.