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Adjusting a prognostic score for burned children with logistic regression
1Unidad de Quemados, Hospital de Pediatria Juan P. Garrahan, Buenos Aires, Argentina.
Insights
A new DEMI score accurately predicts mortality risk in burned children. This validated tool assesses key factors like burn extent and inhalation syndrome for improved patient outcomes.
Area of Science:
- Pediatrics
- Burn Care
- Medical Prognostics
Background:
- Assessing mortality risk in pediatric burn patients is crucial for effective treatment.
- Existing prognostic scores may require refinement for accuracy and applicability.
Purpose of the Study:
- To adjust and cross-validate the DEMI score for predicting mortality in hospitalized burned children.
- To identify key risk factors for mortality in pediatric burn patients.
Main Methods:
- Retrospective analysis of 168 pediatric burn patients to adjust the DEMI score using logistic regression.
- Prospective validation of the adjusted DEMI score on 137 patients.
- The DEMI score assesses burn depth, extension, morbidity, and inhalation syndrome.
Main Results:
- The logistic regression identified percentage total body surface area burned, inadequate transfer, inhalation syndrome, and dorso-gluteal affection as key predictors.
- Cross-validation showed high correlation (R = 0.78) with outcomes.
- The DEMI score demonstrated high sensitivity (80.95%) and specificity (96.55%).
Conclusions:
- The adjusted DEMI score is a simple, accurate tool for predicting mortality risk in burned children.
- The DEMI score can aid in clinical decision-making and resource allocation for pediatric burn care.
Abstract:
This study was aimed at the adjustment and cross-validation of a prognostic score for burned children on hospital admission. DEMI score assesses seven risk factors related to four main topics: depth (percent of partial-thickness and full-thickness burn), extension (percent of total body surface area burned and injury to dorso-gluteal area), morbidity on admission (preexisting illness and complications caused by inadequate transfer), and presence of Inhalation syndrome. These items were selected in a previous case control study with bivariate analysis on an estimation sample of 168 children with acute burns admitted to the burn unit of the Hospital de Pediatria Juan P. Garrahan between July 1991 and October 1993. This study uses the same retrospective sample to adjust this score by means of multivariate analysis. Only four items were included in the logistic regression formula: percentage total body surface area burned, inadequate transfer, inhalation syndrome, and dorso-gluteal affection. Resulting abbreviation of DEMI score was then cross-validated on a prospective validation sample of 137 patients, yielding high correlation with the outcome (R = 0.78) and high sensitivity (80.95%), specificity (96.55%), and positive (80.95%) and negative (96.55%) predictive values. We conclude that this new DEMI score is a simple and accurate tool to predict mortality risk in burned children.