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Evaluating the prognosis of multiple, severely traumatized children in the intensive care unit
1Department of Pediatric Anesthesiology and Intensive Care, La Timone Children's Hospital, Bd Jean Moulin, 13385 Marseille, France.
Insights
The Pediatric Risk of Mortality (PRISM) score accurately predicts survival in severely injured children. The Glasgow Coma Scale (GCS) score also shows high accuracy, especially with head trauma, offering a simpler alternative for prognosis.
Area of Science:
- Pediatric critical care medicine
- Trauma surgery
- Biostatistics
Background:
- Severe multiple trauma in children presents significant challenges in predicting outcomes.
- Accurate prognostic tools are essential for guiding clinical decisions and resource allocation in Pediatric Intensive Care Units (PICUs).
Purpose of the Study:
- To evaluate the effectiveness of the Pediatric Risk of Mortality (PRISM) score in children with severe multiple trauma.
- To identify additional factors influencing prognosis in this patient population.
Main Methods:
- Retrospective analysis of 133 severely traumatized children over a 9-year period in a university hospital PICU.
- Calculation and comparison of various scoring systems including PRISM, Glasgow Coma Scale (GCS), Pediatric Trauma Score (PTS), Injury Severity Score (ISS), and New ISS (NISS).
- Receiver Operating Characteristic (ROC) curve analysis and univariate/multivariate logistic regression were used to assess predictive accuracy and identify risk factors.
Main Results:
- The overall mortality rate was 25.6%.
- PRISM demonstrated strong discriminatory ability (Az=0.9387), comparable to the GCS score (Az=0.9451), but superior to ISS, NISS, and PTS.
- Independent risk factors for mortality included PRISM >35 and GCS <7. Head trauma was significantly associated with death.
Conclusions:
- The PRISM score is a reliable and validated tool for assessing prognosis in severely injured pediatric trauma patients.
- The GCS score, due to its simplicity and comparable accuracy to PRISM, is also a valuable tool, particularly given the impact of head trauma on mortality.
- Both PRISM and GCS are effective in predicting survival in this critically ill population.
Objective:
To assess the Pediatric Risk of Mortality (PRISM) score and to identify other prognosis factors in severe, multiple trauma in children.
Design:
Retrospective study over a 9-year period.
Setting:
A Pediatric Intensive Care Unit (PICU) in a University Hospital.
Patients And Participants:
One hundred and thirty-three traumatized children, 8.6 years (8 months-16 years), were reviewed.
Interventions:
None.
Measurements And Results:
Pediatric Trauma Score (PTS), Injury Severity Score (ISS), New ISS (NISS), Glasgow Coma Scale (GCS) score, and PRISM were calculated. The areas under the Receiver Operating Characteristic (ROC Az) curves, were compared. Univariate and multivariate analyses were performed. The mortality rate was 25.6%. PRISM performed well for discrimination between survivors and non-survivors. Az PRISM 0.9387 (0.029) was not different from Az GCS score 0.9451 (0.027) (P=0.568), but was significantly different from Az ISS 0.756 (0.052) (P<0.001), Az NISS 0.7606 (0.051) (P<0.001), and Az PTS 0.8244 (0.047) (P=0.016). Death was significantly associated with head trauma (P=0.014), PRISM >35, PTS <5, GCS <7, and ISS or NISS >32 (P<0.00001). PRISM >35 (P=0.001) and GCS <7 (P=0.003) were independent risk factors of death.
Conclusions:
PRISM is a reliable tool for evaluating the prognosis of multiple, severely traumatized children. Its relative simplicity and the fact that it is extremely widespread as a general prognosis score in PICUs represent other arguments for its use. Due to the leading influence of head trauma on mortality, GCS, a score even simpler than PRISM, showed identical accuracy regarding survival prediction.