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The penetrating injury risk of non-home discharge (PIRD) score: Development and validation of a predictive tool using
Rohan Phadke1, Samer Salman1, Muhammad H Ilyas2
1School of Medicine, Baylor College of Medicine, Houston, TX, United States.
Insights
The new Penetrating Injury Risk of Non-home Discharge (PIRD) score accurately predicts which trauma patients need post-acute care. This tool aids early discharge planning for survivors of penetrating trauma.
Area of Science:
- Trauma Surgery
- Rehabilitation Medicine
- Health Services Research
Background:
- Penetrating trauma survivors often require post-acute care, complicating discharge planning.
- Early identification of patients needing rehabilitation is crucial but lacks validated tools.
- The Penetrating Injury Risk of Non-home Discharge (PIRD) score was developed for this purpose.
Purpose of the Study:
- To develop and validate a predictive tool for non-home discharge in adult penetrating trauma patients.
- To identify early predictors of post-acute care needs.
- To improve discharge planning and resource allocation for trauma survivors.
Main Methods:
- Utilized the National Trauma Data Bank (NTDB) from 2019-2024, including 302,399 adult penetrating trauma survivors.
- Split data into derivation (2:1) and validation sets, stratifying by outcome (home vs. non-home discharge).
- Applied multivariable logistic regression to identify predictors available early in hospital care, including demographics, injury severity (ISS), and comorbidities.
Main Results:
- The PIRD score demonstrated strong predictive performance (AUROC 0.866) and excellent calibration.
- Key predictors included spinal-cord injury, high Injury Severity Score (ISS ≥25), advanced age, and severe traumatic brain injury.
- The score effectively stratified risk, with non-home discharge rates ranging from 0.7% (low risk) to 37.5% (high risk).
Conclusions:
- The PIRD score accurately predicts the need for post-acute care in penetrating trauma patients.
- It outperforms existing trauma severity scores in predicting non-home discharge.
- The PIRD score supports timely discharge planning and efficient resource allocation for trauma survivors.
Background:
Penetrating trauma disproportionately affects young patients, yet many survivors cannot be discharged directly home and instead require post-acute care. Identifying these patients early could expedite rehabilitation referral and discharge planning, but no validated tool predicts non-home discharge in penetrating trauma. We developed and internally validated the Penetrating Injury Risk of Non-home Discharge (PIRD) score.
Methods:
Using the National Trauma Data Bank (NTDB) Trauma Quality Improvement Program Participant Use Files (2019-2024), we selected adult patients (≥18 years) with penetrating trauma who survived to discharge. The outcome was non-home discharge to post-acute care (e.g., skilled nursing or inpatient rehabilitation) versus home. The cohort was split 2:1 into derivation and validation sets, stratified by outcome. Candidate predictors available early in the hospital course (demographics, insurance, mechanism, emergency-department physiology, the Injury Severity Score [ISS], body-region injury, transport, and comorbidities) underwent univariate screening, collinearity assessment, and backward-stepwise multivariable logistic regression. Unlike the orthopedic FORD score, ISS was retained because penetrating trauma is a high-severity, mortality-driven population. Coefficients were converted to integer points, scaled 0-10.
Results:
Among 302,399 patients, 21,186 (7.0%) had non-home discharge. The 40-predictor model was led by spinal-cord injury, critical injury severity (ISS ≥25), advanced age, and severe traumatic brain injury, whereas stab mechanism and private-vehicle arrival lowered the odds. Validation discrimination was strong (area under the receiver operating characteristic curve [AUROC] 0.866, 95% confidence interval 0.861-0.871) with excellent calibration (Brier 0.046, calibration slope 1.00), exceeding the GTOS-II, TRIAGES, FORD, and DEPARTS scores (all p < 0.001). Non-home discharge rose from 0.7% (low risk) to 37.5% (high risk); at a score ≥4, sensitivity was 86.0% and negative predictive value 98.5%.
Conclusion:
Derived from variables available early in care, the PIRD score accurately predicts post-acute care discharge in adult penetrating trauma and outperforms existing severity scores, supporting timely discharge planning and resource allocation.
