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Resource use, efficiency, and outcome prediction in pediatric intensive care of trauma patients
S A Klem1, M M Pollack, N L Glass
1Department of Critical Care, Children's Hospital National Medical Center, Washington, D.C. 20010.
Insights
Trauma patients in Pediatric Intensive Care Units (PICUs) use resources proportionally but less efficiently than other patients. However, established scoring systems accurately predict mortality risk for these pediatric trauma cases.
Area of Science:
- Pediatric Intensive Care
- Trauma Medicine
- Healthcare Resource Management
Background:
- Trauma patients represent a significant, yet distinct, patient population within Pediatric Intensive Care Units (PICUs).
- Understanding their resource utilization and outcomes is crucial for optimizing care delivery.
Purpose of the Study:
- To evaluate the resource consumption and mortality risk of trauma patients admitted to PICUs.
- To assess the predictive accuracy of the Physiologic Stability Index (PSI) and Pediatric Risk of Mortality (PRISM) scores for trauma patients.
Main Methods:
- Retrospective review of 164 trauma patients from 1,075 consecutive admissions across five PICUs.
- Daily data collection on resource use (Therapeutic Intervention Scoring System [TISS] points) and mortality risk scores (PSI and PRISM).
Main Results:
- Trauma patients accounted for 15.2% of admissions, utilizing 14.9% of care days and 14.5% of TISS points.
- Care efficiency for trauma patients (75%) was lower than for nontrauma patients (79%, p < 0.001).
- Trauma patient mortality was 9.8%, with PSI and PRISM scores demonstrating accurate outcome prediction (p > 0.50 for both).
Conclusions:
- Trauma patients are a minority in PICUs, with resource use proportional to their numbers.
- Pediatric trauma patient care is less efficient compared to nontrauma cases.
- PSI and PRISM scores are reliable tools for predicting mortality in pediatric trauma patients.
Abstract:
To study the impact of trauma patients on Pediatric Intensive Care Units (PICUs), 164 trauma patients' data from 1,075 consecutive admissions to five PICUs were reviewed. Resource use (Therapeutic Intervention Scoring System [TISS] points) and mortality risks (Physiologic Stability Index [PSI] and Pediatric Risk of Mortality [PRISM] scores) were obtained daily for all patients. Trauma patients constituted 15.2% of all PICU patients, and used 14.9% of patient care days and 14.5% of TISS points. Efficiency of trauma patient care was 75% overall compared to 79% overall for nontrauma patients (p less than 0.001). Trauma patient mortality was 9.8%. Tests for goodness of fit showed the PSI and PRISM scores to be accurate outcome predictors for trauma patients (PSI: chi 2 (4) = 2.852, p greater than 0.50; PRISM: chi 2 (4) = 1.216, p greater than 0.50). Trauma patients are a minority of PICU patients and deaths. Their resource use is proportional to their numbers, although less efficient than for nontrauma patients. PSI and PRISM are accurate mortality risk predictors for trauma patients.