Comparison of Scoring Systems for Mortality Prediction in Pediatric Multitrauma Patients

Abstract

The aim of this study was to compare scoring systems for mortality prediction and determine the threshold values of these scoring systems in pediatric multitrauma patients. A total of 57 multitrauma patients referred to the pediatric intensive care unit from January 2020 to August 2021 were included. The pediatric trauma score (PTS), injury severity score (ISS), base deficit (B), international normalized ratio (I), Glasgow coma scale (G) (BIG) score, and pediatric risk of mortality 3 (PRISM 3) score were analyzed for all patients. Of the study group, 35% were female and 65% were male with a mean age of 72 months (interquartile range: 140). All groups' mortality ratio was 12.2%. All risk scores based on mortality prediction were statistically significant. Cutoff value for PTS was 3.5 with 96% sensitivity and 62% specificity; for the ISS, it was 20.5 with 92% sensitivity and 43% specificity; threshold of the BIG score was 17.75 with 85.7% sensitivity and 34% specificity; and 12.5 for PRISM 3 score with 87.6% sensitivity and 28% specificity. PTS, ISS, BIG score, and PRISM 3 score were accurate risk predictors for mortality in pediatric multitrauma patients. ISS was superior to PTS, PRISM 3 score, and BIG score for discrimination between survivors and nonsurvivors.

Keywords

multitrauma - injury severity score - pediatric trauma score - BIG score - pediatric risk of mortality 3 score

Authors' Contributions

M.Ç. contributed in conceptualization, design, data collection, and writing. K.Ç. contributed in analysis, supervision, literature search, critical revision, and writing.

Publikationsverlauf

Eingereicht: 09. September 2021

Angenommen: 25. Oktober 2021

Artikel online veröffentlicht:
07. Dezember 2021

• References

• 1 Mokdad AH, Forouzanfar MH, Daoud F. et al. Global burden of diseases, injuries, and risk factors for young people's health during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2016; 387 (10036): 2383-2401
• 2 Sullivan T, Haider A, DiRusso SM, Nealon P, Shaukat A, Slim M. Prediction of mortality in pediatric trauma patients: new injury severity score outperforms injury severity score in the severely injured. J Trauma 2003; 55 (06) 1083-1087 , discussion 1087–1088
• 3 Walker PA, Harting MT, Baumgartner JE, Fletcher S, Strobel N, Cox Jr CS. Modern approaches to pediatric brain injury therapy. J Trauma 2009; 67 (2, Suppl): S120-S127
• 4 Alexiou GA, Sfakianos G, Prodromou N. Pediatric head trauma. J Emerg Trauma Shock 2011; 4 (03) 403-408
• 5 Sharma BR. Triage in trauma-care system: a forensic view. J Clin Forensic Med 2005; 12 (02) 64-73
• 6 Trabold F, Meyer PG, Blanot S, Carli PA, Orliaguet GA. The prognostic value of transcranial Doppler studies in children with moderate and severe head injury. Intensive Care Med 2004; 30 (01) 108-112
• 7 Sultanoğlu H, Özkan S, Erdem Sultanoğlu T. et al. Comparison of trauma scoring systems in pediatric trauma patients. Eurasian J Emerg Med 2019; 18 (01) 1-8
• 8 Marcin JP, Pollack MM. Triage scoring systems, severity of illness measures, and mortality prediction models in pediatric trauma. Crit Care Med 2002; 30 (11, Suppl): S457-S467
• 9 Ducrocq SC, Meyer PG, Orliaguet GA. et al. Epidemiology and early predictive factors of mortality and outcome in children with traumatic severe brain injury: experience of a French pediatric trauma center. Pediatr Crit Care Med 2006; 7 (05) 461-467
• 10 Sahin T, Batın S. A descriptive study of orthopaedic injuries due to parachute jumping in soldiers. BMC Emerg Med 2020; 20 (01) 58
• 11 Pollack MM, Dean JM, Butler J. et al. The ideal time interval for critical care severity-of-illness assessment. Pediatr Crit Care Med 2013; 14 (05) 448-453
• 12 Thanapaisal C, Wongkonkitsin N, Seow OT. et al. Outcome of in-patient trauma cases: Accident and Emergency Unit, Khon Kaen University. J Med Assoc Thai 2005; 88 (11) 1540-1544
• 13 Gabbe BJ, Cameron PA, Finch CF. The status of the Glasgow coma scale. Emerg Med (Fremantle) 2003; 15 (04) 353-360
• 14 Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated pediatric risk of mortality score. Crit Care Med 1996; 24 (05) 743-752
• 15 Castello FV, Cassano A, Gregory P, Hammond J. The pediatric risk of mortality (PRISM) score and injury severity score (ISS) for predicting resource utilization and outcome of intensive care in pediatric trauma. Crit Care Med 1999; 27 (05) 985-988
• 16 Klem SA, Pollack MM, Glass NL. et al. Resource use, efficiency, and outcome prediction in pediatric intensive care of trauma patients. J Trauma 1990; 30 (01) 32-36
• 17 Yousefzadeh-Chabok S, Kazemnejad-Leili E, Kouchakinejad-Eramsadati L. et al. Comparing pediatric trauma, Glasgow coma scale and injury severity scores for mortality prediction in traumatic children. Ulus Travma Acil Cerrahi Derg 2016; 22 (04) 328-332
• 18 Grinkeviciūte DE, Kėvalas R, Šaferis V, Matukevicius A, Ragaisis V, Tamasauskas A. Predictive value of scoring system in severe pediatric head injury. Medicina (Kaunas) 2007; 43 (11) 861-869
• 19 Tohira H, Jacobs I, Mountain D, Gibson N, Yeo A. Systematic review of predictive performance of injury severity scoring tools. Scand J Trauma Resusc Emerg Med 2012; 20: 63
• 20 Brown JB, Gestring ML, Leeper CM. et al. The value of the injury severity score in pediatric trauma: time for a new definition of severe injury?. J Trauma Acute Care Surg 2017; 82 (06) 995-1001
• 21 Brockamp T, Maegele M, Gaarder C. et al. Comparison of the predictive performance of the BIG, TRISS, and PS09 score in an adult trauma population derived from multiple international trauma registries. Crit Care 2013; 17 (04) R134
• 22 Davis AL, Wales PW, Malik T, Stephens D, Razik F, Schuh S. The BIG score and prediction of mortality in pediatric blunt trauma. J Pediatr 2015; 167 (03) 593-598