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Predictive factors of outcome in severely traumatized children
G A Orliaguet1, P G Meyer, S Blanot
1Department of Anesthesiology and Critical Care, Hôpital Necker-Enfants Malades, Paris, France.
Insights
Identifying risk factors for death in severely injured children is crucial. High Injury Severity Score (ISS), low Glasgow Coma Scale (GCS) score, and emergency blood transfusions are key predictors of mortality in pediatric trauma.
Area of Science:
- Pediatric Trauma Research
- Injury Epidemiology
- Critical Care Medicine
Background:
- Trauma outcome assessment tools are often adult-derived and may be inaccurate for children.
- Pediatric trauma carries a significant mortality risk, necessitating identification of specific risk factors.
- Previous studies have not comprehensively evaluated risk factors for mortality in severely injured children.
Purpose of the Study:
- To identify independent risk factors associated with death in severely traumatized children.
- To establish threshold values for predictive factors of mortality in pediatric trauma patients.
- To improve the accuracy of outcome prediction in pediatric trauma care.
Main Methods:
- Prospective study of 507 consecutive pediatric trauma patients admitted to a Level I trauma center.
- Calculation of Pediatric Trauma Score (PTS), Glasgow Coma Scale (GCS) score, and Injury Severity Score (ISS).
- Univariate and multivariate analyses, including Receiver Operating Characteristic (ROC) curves, to identify significant risk factors and threshold values.
Main Results:
- The overall mortality rate was 12%.
- Independent risk factors for death included ISS ≥ 25, GCS score ≤ 7, emergency blood transfusion ≥ 20 mL/kg, and PTS ≤ 4.
- The probability of death ranged from 0% (no risk factors) to 63% (all risk factors present).
Conclusions:
- Established scoring systems like ISS and GCS, along with immediate blood transfusion needs, are critical predictors of mortality in severely injured children.
- The identified risk factors and their threshold values provide a more accurate tool for assessing mortality risk in pediatric trauma.
- These findings can aid in clinical decision-making and resource allocation for critically injured children.
Unlabelled:
To identify risk factors associated with death in traumatized children, we prospectively studied 507 consecutive patients (7+/-4 yr) admitted to a level I pediatric trauma center over a 3-yr period. Pediatric Trauma Score (PTS), Glasgow Coma Scale (GCS) score, and Injury Severity Score (ISS) were calculated. Age, injury mechanism, injury pattern, and initial critical care were recorded. Univariate and multivariate analyses were performed for potential risk factors associated with mortality. Receiver operating characteristic curves were used to determine threshold values of variables identified by univariate analysis. Most children suffered from blunt trauma (99.6%), and head trauma was noted in 85%. Median values (range) of GCS scores, PTS, and ISS were 10 (3-15), 7 (-4 to 12), and 16 (3-75), respectively. The mortality rate was 12%. Using multivariate analysis, death was significantly associated with an ISS > or = 25 (odds ratio [OR] 22.2, 95% confidence interval 2.8-174.9), GCS score < or = 7 (OR 4.77, 1.8-12.7), emergency blood transfusion > or = 20 mL/kg (OR 4.3, 2.1-9.1), and PTS < or = 4 (OR 3.7, 1.4-9.7). An ISS > or = 25, GCS score < or = 7, immediate blood transfusion > or = 20 mL/kg, and PTS < or = 4 were significant and independent risk factors of death in an homogenous population of severely injured children. The probability of traumatic death was therefore 0 (95% confidence interval 0-0.0135) in children with no one of these threshold values in the four predictive factors and 0.63 (95% confidence interval 0.47-0.76) in those children with all the threshold values.
Implications:
Methods used for evaluating outcome of trauma patients have essentially been derived from adult series, and attempts to apply them to children have usually been inaccurate. Univariate and multivariate analyses were performed to identify risk factors associated with death in severely traumatized children, and Receiver operating characteristic curves were used to determine threshold values.