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Use of Rotterdam CT scores for mortality risk stratification in children with traumatic brain injury
Kate Liesemer1, Jay Riva-Cambrin, Kimberly Statler Bennett
11Pediatric Critical Care, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, UT. 2Pediatric Neurosurgery, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, UT. 3Emergency Medicine, University of Rochester School of Medicine, Rochester, NY. 4Pediatric Surgery, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, UT.
Insights
The Rotterdam CT score, used for adult traumatic brain injury, showed poor calibration for predicting pediatric mortality. A new pediatric model accurately stratifies mortality risk in children with traumatic brain injury.
Area of Science:
- Neurotrauma
- Pediatric Critical Care
- Radiology
Background:
- The Rotterdam CT score categorizes adult traumatic brain injury (TBI) severity.
- Its utility in pediatric TBI mortality risk stratification is unestablished.
Purpose of the Study:
- To evaluate the Rotterdam CT score's effectiveness in predicting mortality in pediatric TBI.
- To develop and validate a pediatric-specific mortality prediction model.
Main Methods:
- Compared observed pediatric mortality with adult Rotterdam CT score predictions.
- Developed a new pediatric mortality model using a cohort of 632 children with moderate to severe TBI.
- Validated the model using a separate sample from the same cohort.
Main Results:
- The adult Rotterdam CT score showed good discrimination (AUC=0.85) but poor calibration for pediatric TBI mortality.
- A newly developed pediatric model demonstrated good discrimination (AUC=0.80) and calibration.
- Children exhibited better survival than adults in lower Rotterdam score categories but worse survival in higher categories.
Conclusions:
- The adult Rotterdam CT score is not ideal for pediatric TBI mortality risk stratification.
- A validated, pediatric-specific mortality model accurately predicts outcomes in children with TBI.
- This new model can aid in clinical decision-making and resource allocation for pediatric TBI.
Objectives:
The Rotterdam CT score refined features of the Marshall score and was designed to categorize traumatic brain injury type and severity in adults. The objective of this study was to determine whether the Rotterdam CT score can be used for mortality risk stratification after pediatric traumatic brain injury.
Design:
In children with moderate to severe traumatic brain injury, a comparison of observed versus predicted mortality was calculated using published model probabilities of adult mortality. Development and validation of a new pediatric mortality model using randomly selected prediction and validation samples from our cohort.
Setting:
A single level 1 pediatric trauma center.
Subjects:
Six hundred thirty-two children with moderate or severe traumatic brain injury.
Interventions:
None.
Measurements And Main Results:
Sixteen percent of the patients (101 of 632) died prior to hospital discharge. The predicted mortality based on Rotterdam score for adults with moderate or severe traumatic brain injury discriminated pediatric observed mortality well (area under the curve = 0.85; 95% CI, 0.80-0.89) but had poor calibration, overestimating or underestimating mortality for children in several Rotterdam categories. A predictive model based on children with moderate or severe traumatic brain injury from the single center discriminated mortality well (area under the curve, 0.80; 95% CI, 0.68-0.91) and showed good calibration and overall fit.
Conclusions:
Children with traumatic brain injury have better survival than adults in Rotterdam CT score categories representing less severe injuries but worse survival than adults in higher score categories. A novel, validated pediatric mortality model based on the Rotterdam score is accurate in children with moderate or severe traumatic brain injury and can be used for risk stratification.
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