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Pediatric risk indicator: an objective measurement of childhood injury severity
J J Tepas1, H C Veldenz, C Discala
1Department of Surgery, University of Florida, Health Science Center Jacksonville, 32209, USA.
Insights
The Pediatric Risk Index (PRI) effectively identifies children at risk of death or severe impairment after injury. This validated tool aids in predicting outcomes and optimizing critical care resource allocation for pediatric trauma patients.
Area of Science:
- Pediatric Trauma Care
- Injury Severity Assessment
- Risk Stratification
Background:
- The Pediatric Risk Index (PRI) integrates physiologic and anatomic severity measures.
- It aims to identify pediatric trauma patients at risk for mortality, impairment, or extensive resource use.
Purpose of the Study:
- To evaluate the effectiveness of the Pediatric Risk Index (PRI) in identifying at-risk pediatric trauma patients.
- To establish a risk discriminant for predicting patient outcomes.
Main Methods:
- Analysis of 5,345 pediatric trauma patients from a 1993 multi-institutional registry.
- Calculation of PRI and comparison of survivor vs. fatality distributions.
- Evaluation of PRI's predictive ability using 1992 injury data.
Main Results:
- A PRI score greater than 1 indicated significant injury-related risk.
- Statistically significant differences (p < 0.001) were found between at-risk and no-risk groups for mortality, ICU stay, and functional independence.
- Analysis of prior year data suggested potentially preventable deaths.
Conclusions:
- The Pediatric Risk Index (PRI) is effective in identifying pediatric trauma patients at risk.
- It accurately predicts mortality, impairment, and the need for intensive care unit resources.
Introduction:
The Pediatric Risk Index (PRI) uses established measures of physiologic derangement (Pediatric Trauma Score and Glasgow Coma Scale) and anatomic severity (Injury Severity Score) to identify those patients at risk of death, impairment, or extensive resource utilization.
Methods:
The PRI was evaluated by analysis of 5,345 patients entered into a multi-institutional pediatric trauma registry during 1993. PRI was calculated for each patient, and its distribution for survivors compared with those of fatalities. Analysis of this distribution identified a risk discriminant which was used to compare resulting cohorts by mortality, intensive care unit stay, and discharge impairment as measured by Functional Independence Measure. To evaluate the PRI's ability to identify unexpected outcome the records of 7,319 children injured in 1992 were then compared to the "standards" developed from the 1993 data.
Results:
Mortality distribution analysis identified a PRI > 1 as an indication of injury related risk. For mortality, intensive care unit stay, and discharge Functional Independence Measurement, there was a statistically significant difference (chi2, p < 0.001) between the at-risk and no-risk populations. Comparison of 1992 experience demonstrated at least one potentially preventable death.
Conclusions:
The PRI effectively identifies injured patients at risk for dying, impairment, or extensive intensive care unit care.