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Two novel resource-based metrics to quantify pediatric trauma severity based on probability of requiring critical
Christopher W Snyder1, David J Ciesla, Joseph J Tepas
1From the Division of Pediatric Surgery (C.W.S., N.M.C., P.D.S., R.G.), Johns Hopkins All Children's Hospital, St. Petersburg; Division of Trauma and Acute Care Surgery (D.J.C.), University of South Florida, Tampa; Division of Pediatric Surgery (J.J.T., K.P., N.P.), Wolfson Children's Hospital, Jacksonville; and College of Public Health (E.E.P.), University of South Florida, Tampa, Florida.
Insights
Mortality-based injury severity scores underestimate pediatric trauma burden. Resource-based scores like ICASS and IGASS reveal similar critical care needs for pediatric and adult patients, suggesting they complement existing measures.
Area of Science:
- Trauma research
- Medical informatics
- Public health
Background:
- Mortality-based severity of injury (SOI) metrics, such as the International Classification of Diseases (ICD) Injury Severity Score (ICISS), may not accurately reflect the burden of pediatric traumatic disease due to lower pediatric mortality rates.
- This study addresses the need for resource-based SOI measures to better assess injury severity across different age groups.
Purpose of the Study:
- To develop and validate two novel resource-based SOI measures: the ICD Critical Care Severity Score (ICASS) and the ICD General Anesthesia Severity Score (IGASS).
- To compare the performance of these new measures against the ICISS across pediatric, adult, and elderly patient populations.
Main Methods:
- The ICISS, ICASS, and IGASS were derived using Florida state administrative data from 2012-2016 and validated with 2017 data.
- Logistic regression was employed to validate the predictive capabilities of each SOI measure for mortality, critical care, and anesthesia utilization.
- Distributions of the three SOI measures were compared across pediatric (0-15 years), adult (16-64 years), and elderly (65-84 years) age groups.
Main Results:
- All three measures (ICISS, ICASS, IGASS) were strongly predictive of their respective outcomes (mortality, critical care, anesthesia utilization) (p < 0.001).
- The mean ICISS was significantly lower for pediatric patients (10.6) compared to adults (19.0), suggesting lower mortality risk.
- In contrast, the mean ICASS was similar for pediatric (50.2) and adult (53.2) patients, indicating comparable critical care utilization, with IGASS showing similar patterns.
Conclusions:
- Resource-based SOI measures, such as ICASS and IGASS, indicate that the burden of injury in pediatric patients is comparable to that of adults, contrary to findings from mortality-based measures.
- ICASS and IGASS are validated, easily calculable tools using administrative data that can complement traditional mortality-based measures in pediatric trauma assessment.
Background:
Mortality-based metrics like the International Classification of Diseases (ICD) Injury Severity Score (ICISS) may underestimate burden of pediatric traumatic disease due to lower mortality rates in children. The purpose of this study was to develop and validate two resource-based severity of injury (SOI) measures, then compare these measures and the ICISS across a broad age spectrum of injured patients.
Methods:
The ICISS and two novel SOI measures, termed ICD Critical Care Severity Score (ICASS) and ICD General Anesthesia Severity Score (IGASS), were derived from Florida state administrative 2012 to 2016 data and validated with 2017 data. The ICASS and IGASS predicted the need for critical care services and anesthesia services, respectively. Logistic regression was used to validate each SOI measure. Distributions of ICISS, ICASS, and IGASS were compared across pediatric (0-15 years), adult (16-64 years), and elderly (65-84 years) age groups.
Results:
The derivation and validation cohorts consisted of 668,346 and 24,070 emergency admissions, respectively. On logistic regression, ICISS, ICASS, and IGASS were strongly predictive of observed mortality, critical care utilization, and anesthesia utilization, respectively (p < 0.001). The mean ICISS was 10.6 for pediatric and 19.0 for adult patients (ratio, 0.56), indicating that the predicted mortality risk in pediatric patients was slightly over half that of adults. In contrast, the mean ICASS for pediatric and adult patients was 50.2 and 53.2, respectively (ratio, 0.94); indicating predicted critical care utilization in pediatric patients was nearly the same as that of adults. The IGASS comparisons followed comparable patterns.
Conclusion:
When a mortality-based SOI measure is used, the severity of pediatric injury appears much lower than that of adults, but when resource-based measures are used, pediatric and adult burden of injury appear very similar. The ICASS and IGASS are novel and valid resource-based SOI measures that are easily calculated with administrative data. They may complement mortality-based measures in pediatric trauma.
Level Of Evidence:
Level III, prognostic and epidemiological study.
