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Which Trauma Severity Scores Are Useful in Predicting Pediatric Mortality?
Imane Chedid, Rana Bachir1, Jennifer Rizk1
1From the Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Insights
The reverse shock index multiplied by Glasgow Coma Score (rSIG) best predicts mortality in pediatric trauma patients. This score, along with others like shock index (SI) and reverse SI (rSI), can aid clinical decisions in pediatric trauma care.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Clinical Outcomes Research
Background:
- Pediatric trauma is a leading cause of death.
- Existing trauma severity scores include SI, SIPA, rSI, and rSIG.
- The optimal score for predicting pediatric trauma mortality remains unclear.
Purpose of the Study:
- To evaluate the association between trauma severity scores and mortality in pediatric trauma patients.
- To identify the most effective trauma severity score for predicting outcomes in children.
Main Methods:
- Retrospective analysis of the 2015 US National Trauma Data Bank.
- Inclusion of 67,098 patients aged 1-18 years.
- Multivariate logistic regression to assess the association of SI, rSI, and rSIG with mortality.
Main Results:
- A hospital mortality rate of 3% was observed.
- SI, rSI, and rSIG were significantly associated with mortality (P < 0.05).
- rSIG demonstrated the highest adjusted odds ratio for mortality (8.51), followed by rSI (1.9) and SI (1.3).
Conclusions:
- Several trauma severity scores can predict pediatric trauma mortality.
- The rSIG score is the most effective predictor among those evaluated.
- Incorporating these scores into pediatric trauma evaluation algorithms can improve clinical decision-making.
Background And Objectives:
Trauma is the leading cause of death in children. Several trauma severity scores exist: the shock index (SI), age-adjusted SI (SIPA), reverse SI (rSI), and rSI multiplied by Glasgow Coma Score (rSIG). However, it is unknown which is the best predictor of clinical outcomes in children. Our goal was to determine the association between trauma severity scores and mortality in pediatric trauma.
Design And Methods:
A multicenter retrospective study was performed using the 2015 US National Trauma Data Bank, including patients 1 to 18 years old and excluding patients with unknown emergency department dispositions. The scores were calculated using initial emergency department parameters. Descriptive analysis was carried out. Variables were stratified by outcome (hospital mortality). Then, for each trauma score, a multivariate logistic regression was conducted to determine its association with mortality.
Results:
A total of 67,098 patients with a mean age of 11 ±5 years were included. Majority of the patients were male (66%) and had an injury severity score <15 (87%). Eighty-four percent of patients were admitted: 15% to the intensive care unit and 17% directly to the operating room. The mortality at hospital discharge was 3%.There was a statistically significant association between SI, rSI, rSIG, and mortality ( P < 0.05). The highest adjusted odds ratio for mortality corresponded to rSIG, followed by rSI then SI (8.51, 1.9, and 1.3, respectively).
Conclusion:
Several trauma scores may help predict mortality in children with trauma, the best being rSIG. Introduction of these scores in algorithms for pediatric trauma evaluations can impact clinical decision-making.
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