Predictive value of scoring system in severe pediatric head injury
Dovile Evalda Grinkeviciūte1, Rimantas Kevalas, Viktoras Saferis
1Department of Children's Diseases, Kaunas University of Medicine, Kaunas, Lithuania. dovilgrin@hotmail.com
Insights
This study identified critical threshold values for the Pediatric Index of Mortality 2 (PIM 2), Pediatric Trauma Score (PTS), and Glasgow Coma Scale (GCS) to predict mortality in children with severe head injuries. The PIM 2 score demonstrated the best predictive accuracy for outcomes.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Clinical outcome prediction
Background:
- Severe head injury in children presents a significant challenge in pediatric intensive care.
- Accurate prognostic tools are essential for timely intervention and resource allocation.
- Existing scoring systems require validation for specific pediatric populations with head trauma.
Purpose of the Study:
- To establish mortality threshold values for the Pediatric Index of Mortality 2 (PIM 2), Pediatric Trauma Score (PTS), and Glasgow Coma Scale (GCS) in children with severe head injuries.
- To assess the predictive performance of these scores for mortality.
- To evaluate changes in patient outcomes at discharge and 6 months post-injury.
Main Methods:
- Prospective study of 59 children with severe head injury admitted to a Pediatric Intensive Care Unit.
- Calculation of initial PTS, post-resuscitation GCS, and PIM 2 scores.
- Assessment of outcomes using the Glasgow Outcome Scale at discharge and 6 months.
Main Results:
- The study included 59 children (62.7% boys, mean age 10.6 years).
- Mortality rate was 22.0% (13 out of 59 patients).
- Thresholds for increased mortality risk were PIM 2 >= 10.75, PTS <= 3, and GCS <= 5. PIM 2 showed the best discrimination between survivors and non-survivors.
Conclusions:
- The identified threshold values (PIM 2 >= 10.75%, PTS <= 3, GCS <= 5) are significant risk factors for mortality in pediatric severe head trauma.
- The PIM 2 score is a highly effective predictor of mortality in this population.
- Outcomes for survivors showed statistically significant improvement between discharge and 6 months.
Objectives:
To determine the threshold values of Pediatric Index of Mortality 2 (PIM 2) score, Pediatric Trauma Score (PTS), and Glasgow Coma Scale (GCS) score for mortality in children after severe head injury and to evaluate changes in outcomes of children after severe head injury on discharge and after 6 months.
Material And Methods:
All children with severe head injury admitted to the Pediatric Intensive Care Unit of Kaunas University of Medicine Hospital, Lithuania, from January 2004 to June 2006 were prospectively included in the study. The severity of head injury was categorized according to the GCS score < or =8. As initial assessment tools, the PTS, postresuscitation GCS, and PIM 2 scores were calculated for each patient. Outcome was assessed according to Glasgow Outcome Scale on discharge and after 6 months.
Results:
The study population consisted of 59 children with severe head injury. The group consisted of 37 (62.7%) boys and 22 (37.3%) girls; the mean age was 10.6+/-6.02. The mean GCS, PTS, and PIM 2 scores were 5.9+/-1.8, 4.8+/-2.7, and 14.0+/-19.5, respectively. In terms of overall outcome, 46 (78.0%) patients survived and 13 (22.0%) died. All three scales appeared to be significant predictors of death. Threshold values for which potential mortality in children after severe head injury increased were 10.75 for PIM 2, 3 for PTS and 5 for GCS. PIM 2 score provided the best discrimination between survivors and nonsurvivors.
Conclusions:
The threshold values for mortality in children after severe head trauma were PIM 2> or =10.75%, PTS< or =3 and GCS< or =5, and these values were significant risk factors of death in severely head injured children. The changes in outcome for survivals on discharge and after 6 months were statistically significant.
