Comparing Pediatric Trauma Score, Glasgow Coma Scale, and Injury Severity Score for Mortality Prediction in Traumatic Children (original) (raw)
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2020
In this study, we aimed to investigate the effectiveness of trauma scoring systems for predicting the sepsis and multiple organ failure in pediatric trauma patients. A total of 330 trauma patients with 112 children and 218 adults admitted to the emergency service of the university hospital which had level 1 trauma center properties between 01.01.2006 and 01.01.2010 were included in the study. Trauma scores such as Injury Severity Score (ISS), New Injury Severity Score (NISS), Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS) were calculated by screening the files and computer records of the patients during clinic visits. The average of ISS, NISS, RTS and GCS scores were statistically significant in pediatric trauma patients in whom mortality was observed than in the patients without mortality observed (p=0.001). The average of ISS, NISS, RTS and GCS scores were statistically significant in adult trauma patients in whom mortality was observed than in the patients without mortal...
Risk prediction score for death of traumatised and injured children
BMC Pediatrics
Injury prediction scores facilitate the development of clinical management protocols to decrease mortality. However, most of the previously developed scores are limited in scope and are non-specific for use in children. We aimed to develop and validate a risk prediction model of death for injured and Traumatised Thai children. Our cross-sectional study included 43,516 injured children from 34 emergency services. A risk prediction model was derived using a logistic regression analysis that included 15 predictors. Model performance was assessed using the concordance statistic (C-statistic) and the observed per expected (O/E) ratio. Internal validation of the model was performed using a 200-repetition bootstrap analysis. Death occurred in 1.7% of the injured children (95% confidence interval [95%CI]: 1.57-1.82). Ten predictors (i.e., age, airway intervention, physical injury mechanism, three injured body regions, the Glasgow Coma Scale, and three vital signs) were significantly associa...
Predictive Accuracy of Paediatric Trauma Score, our experience at Children Hospital, Lahore
Pakistan Journal of Medical and Health Sciences
Aim: To find predictive accuracy of pediatric trauma score (PTS) in terms of mortality in the Children’s hospital and institute of child health Lahore. Study design: Cross sectional study. Setting: Paediatric Surgery department, CH & ICH, Lahore. Duration of study: 1st January 2019 to 30th June 2019. Methods: All patients presented with trauma, aged 1-15 years were included in study. All patients with major burn, associated cardiac injuries (e.g., stab heart), victims who required monitoring and hospitalization less than 24 hours, and those referred to other hospitals were excluded from the study. Initial assessment of all patients was done and paediatric trauma score was evaluated in the emergency room. Patients were managed and 24 hours follow-up was done to predict the mortality. Results: From 290 children, 207(71.38%) were males and 83 (28.6%) were females. Mean age of the children was 7.53 years. The most common mode of trauma was Car accident in children 67(23.1%), followed by...
The prognostic importance of trauma scoring systems in pediatric patients
Pediatric Surgery International, 2009
Purpose Traumas are among important causes of morbidity and mortality in the pediatric group. Our aim was to evaluate the predicting effects of general trauma scores on mortality and morbidity rates. Methods The files of 74 patients, who were admitted to our hospital with trauma between the years 2006 and 2008, were retrospectively investigated. Patients’ ages, sex, types of trauma, the time between the trauma and entrance to the hospital, vital and laboratory findings, length of hospital stay, length of intensive care unit (ICU) stay, surgical interventions, the organs affected by the trauma, morbidity, and mortality rates were recorded., glasgow coma scale (GCS), abbreviated injury scale (AIS), trauma score—injury severity score (TRISS), revised trauma score (RTS), injury severity score (ISS), pediatric trauma score (PTS), specific trauma scores for lung, liver, and spleen were calculated using the data in the files. Results The mean age of patients was 7.0 ± 4.34 (1–16) years and 50% of them were men. The types of the trauma were blunt in 66 (89.2%) patients, penetrating in 5 (6.8%) patients and injury due to gun shot in 3 (4.1%) patients. The mean time between the trauma and entrance to the emergency service was 80.40 ± 36.67 (10–120) min. Emergency operation and elective surgery was performed in 13 (17%) and 20 (27%) patients, respectively. The mean length of hospitalization was 4.50 ± 7.93 (1–35) days.Seven (9.5%) patients needed ICU. The morbidity and mortality rates were 60.8% (n = 45) and 2.7% (n = 2), respectively. AIS, ISS, TRISS and PTS were independent predictors of morbidity (p p p Conclusion ISS was found to be more valuable than other trauma scoring systems for prognostic evaluation of pediatric trauma patients. On the other hand, blood glucose, AST, and ALT are easily available, cheap, and valuable alternative laboratory findings in prognostic evaluation.
Journal of Pediatric Surgery, 2014
Background/Purpose: Researchers are constantly challenged to identify optimal mortality risk adjustment methodologies that perform accurately in pediatric trauma patients. This study evaluated the new Trauma Mortality Prediction Model (TMPM-ICD-9) in pediatric trauma patients. Methods: Data were analyzed on 107,104 pediatric trauma patients included in the NTDB® in 2010 who had both a valid ISS and probability of death using TMPM-ICD-9. Discrimination was compared using the area under the receiver operator characteristic curve (AUC) and by age, blunt vs penetrating, intent, Glasgow Coma Scale (GCS), and number of injuries. Results: The AUC for TMPM-ICD-9 demonstrated excellent discrimination in predicting mortality versus ISS overall, 11 to 17 years of age (0.96 vs 0.93), by injury type, intent, and in the lowest GCS scores. The TMPM-ICD-9 showed superior discrimination over ISS in patients with more than two injuries. Conclusions: The TMPM demonstrated superior discrimination compared to ISS. The TMPM shows promise of a much needed and simple to use risk adjustment tool with application to both adult and pediatric patients. Researchers should continue to validate this tool in robust pediatric data sets.
Development of a novel age-specific pediatric trauma score
Journal of Pediatric Surgery, 2001
Background/Purpose: Trauma scoring systems are needed to provide efficient triage of injured patients and to assess differences in outcomes and quality of care between different trauma centers, Current scoring systems used in pediatric trauma are not age specific, and thus have significant limitations.
The journal of trauma and acute care surgery, 2018
An accurate injury severity measurement is essential for the evaluation of pediatric trauma care and outcome research. The traditional Injury Severity Score (ISS) does not consider the differential risks of the Abbreviated Injury Scale (AIS) from different body regions nor is it pediatric specific. The objective of this study was to develop a weighted injury severity scoring (wISS) system for pediatric blunt trauma patients with better predictive power than ISS. Based on the association between mortality and AIS from each of the six ISS body regions, we generated different weights for the component AIS scores used in the calculation of ISS. The weights and wISS were generated using the National Trauma Data Bank (NTDB). The Nationwide Emergency Department Sample (NEDS) was used to validate our main results. Pediatric blunt trauma patients less than 16 years were included, and mortality was the outcome. Discrimination (areas under the receiver operating characteristic curve, sensitivi...
Scientific reports, 2024
Hereby, we aimed to comprehensively compare different scoring systems for pediatric trauma and their ability to predict in-hospital mortality and intensive care unit (ICU) admission. The current registry-based multicenter study encompassed a comprehensive dataset of 6709 pediatric trauma patients aged ≤ 18 years from July 2016 to September 2023. To ascertain the predictive efficacy of the scoring systems, the area under the receiver operating characteristic curve (AUC) was calculated. A total of 720 individuals (10.7%) required admission to the ICU. The mortality rate was 1.1% (n = 72). The most predictive scoring system for in-hospital mortality was the adjusted trauma and injury severity score (aTRISS) (AUC = 0.982), followed by trauma and injury severity score (TRISS) (AUC = 0.980), new trauma and injury severity score (NTRISS) (AUC = 0.972), Glasgow coma scale (GCS) (AUC = 0.9546), revised trauma score (RTS) (AUC = 0.944), pre-hospital index (PHI) (AUC = 0.936), injury severity score (ISS) (AUC = 0.901), new injury severity score (NISS) (AUC = 0.900), and abbreviated injury scale (AIS) (AUC = 0.734). Given the predictive performance of the scoring systems for ICU admission, NTRISS had the highest predictive performance (AUC = 0.837), followed by aTRISS (AUC = 0.836), TRISS (AUC = 0.823), ISS (AUC = 0.807), NISS (AUC = 0.805), GCS (AUC = 0.735), RTS (AUC = 0.698), PHI (AUC = 0.662), and AIS (AUC = 0.651). In the present study, we concluded the superiority of the TRISS and its two derived counterparts, aTRISS and NTRISS, compared to other scoring systems, to efficiently discerning individuals who possess a heightened susceptibility to unfavorable consequences. The significance of these findings underscores the necessity of incorporating these metrics into the realm of clinical practice.
Predictive Factors of Outcome in Severely Traumatized Children
Anesthesia & Analgesia, 1998
To identify risk factors associated with death in traumatized children, we prospectively studied 507 consecutive patients (7-C 4 yr) admitted to a level I pediatric trauma center over a 3-yr period. Pediatric Trauma Score (PTS), Glasgow Coma Scale (GCS) score, and Injury Severity Score (ISS) were calculated. Age, injury mechanism, injury pattern, and initial critical care were recorded. Univariate and multivariate analyses were performed for potential risk factors associated with mortality. Receiver operating characteristic curves were used to determine threshold values of variables identified by univariate analysis. Most children suffered from blunt trauma (99.6%), and head trauma was noted in 85%. Median values (range) of GCS scores, PTS, and ISS were 10 (3-15), 7 (-4 to 12), and 16 (3-75), respectively. The mortality rate was 12%. Using multivariate analysis, death was significantly associated with an ISS ~25 (odds ratio [OR] 22.2, 95% confidence interval 2.8-174.9), GCS score 57 (OR 4.77, LB-12.7), emergency blood transfusion 220 mL/kg (OR 4.3, 2.1-9.1), and PTS 14 (OR 3.7, 1.4-9.7). An ISS 225, GCS score 17, immediate blood transfusion 220 mL/kg, and PTS 54 were significant and independent risk factors of death in an homogenous population of severely injured children. The probability of traumatic death was therefore 0 (95% confidence interval o-0.0135) in children with no one of these threshold values in the four predictive factors and 0.63 (95% confidence interval 0.47-0.76) in those children with all the threshold values.
Children
The shock index (SI) is a useful tool for predicting the injury severity and mortality in patients with trauma. However, pediatric physiology differs from that of adults. In the pediatric trauma population, the shock status may be obscured within the normal range of vital signs. Pediatric age-adjusted SI (SIPA) is reported more accurately compared to SI. In our study, we conducted a 10 year retrospective cohort study of pediatric trauma population to evaluate the SI and SIPA in predicting mortality, intensive care unit (ICU) admission, and the need for surgery. This retrospective cohort study included 1265 pediatric trauma patients from January 2009 to June 2019 at the Taipei Tzu Chi Hospital, who had a history of hospitalization. The primary outcome of this investigation was in-hospital mortality, and the secondary outcomes were the length of hospital and ICU stay, operation times, and ICU admission times. The SIPA group can detect changes in vital signs early to reflect shock prog...