Predictors of in-hospital mortality in children with severe traumatic brain injury

Predictors of mortality in severe traumatic brain injuries (TBI) in pediatric patients are not well explored. We investigate traditional and novel prognostic predictors in pediatric patients with severe TBI. The primary outcome was in-hospital mortality.

A retrospective study of children ⩽18 years old with a Glasgow Coma Scale ⩽8 was conducted at a level I pediatric trauma center. Predictors of mortality included interventions within 72 h, Pediatric Risk of Mortality (PRISM) III at 24 h, and the pediatric Sequential Organ Failure Assessment (pSOFA) score over 3 days. Novel prognostic models included a combined PRISM III and pSOFA score, a model that combined the two prognostic scores with medical interventions, and a combined medical and surgical intervention model. Categorical and continuous variables were analyzed using Fisher's exact test and the Mann-Whitney U test, respectively. Receiver operating characteristic curves and area under the curve (AUC) were used to assess the predictive performance of prognostic scores.

There were 97 patients with severe TBI included in this study. The combined PRISM-pSOFA day 2 model was the strongest predictor of mortality (AUC = 0.973), but did not provide a statistically significant benefit over PRISM III, which served as the referent model. While the PRISM III (AUC = 0.968) had a higher predictive ability than the pSOFA-day 2 (AUC = 0.940), the difference was not statistically significant.

Predicting outcomes is essential for guiding care decisions and standardizing research. The pSOFA-day 2 score offers a comparable mortality prediction to PRISM III and serves as a practical, easy alternative that can be especially helpful when the PRISM III score is unavailable or difficult to calculate due to resource limitations.