Predictors of mortality in pediatric trauma: experiences of a level 1 trauma center and an assessment of the International Classification Injury Severity Score (ICISS)

Casey J. Allen, Amy E. Wagenaar, Davis B. Horkan, Daniel J. Baldor, William M. Hannay, Jun Tashiro, Nicholas Namias, Juan E Sola

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: Injury severity scoring tools allow systematic comparison of outcomes in trauma research and quality improvement by indexing an expected mortality risk for certain injuries. This study investigated the predictive value of the empirically derived ICD9-derived Injury Severity Score (ICISS) compared to expert consensus-derived scoring systems for trauma mortality in a pediatric population. Methods: 1935 consecutive trauma patients aged <18 years from 1/2000 to 12/2012 were reviewed. Mechanism of injury (MOI), Injury Severity Score (ISS), Revised Trauma Score (RTS), Trauma Score ISS (TRISS), and ICISS were compared using univariate and multivariate logistic regression analysis and receiver operator characteristic analysis. Results: The population was a median age of 11 ± 6 year, 70 % male, and 76 % blunt injury. Median ISS 13 ± 12 and overall mortality 3.5 %. Independent predictors of mortality were initial hematocrit [odds ratio (OR) 0.83 (0.73–0.95)], HCO3 [OR 0.82 (0.67–0.98)], Glasgow Coma Scale score [OR 0.75 (0.62–0.90)], and ISS [OR 1.10 (1.04–1.15)]. TRISS was superior to ICISS in predicting survival [area under receiver operator curve: 0.992 (0.982–1.000) vs 0.888 (0.838–0.938)]. Conclusions: ICISS was inferior to existing injury scoring tools at predicting mortality in pediatric trauma patients.

Original languageEnglish (US)
Pages (from-to)657-663
Number of pages7
JournalPediatric Surgery International
Volume32
Issue number7
DOIs
StatePublished - Jul 1 2016

Fingerprint

Injury Severity Score
Trauma Centers
Pediatrics
Mortality
Wounds and Injuries
Odds Ratio
Nonpenetrating Wounds
Glasgow Coma Scale
Quality Improvement
Hematocrit
Population
Logistic Models
Regression Analysis

Keywords

  • Children
  • ICISS
  • Injury
  • Mortality
  • Pediatric Trauma
  • Survival
  • Trauma outcomes
  • TRISS

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Predictors of mortality in pediatric trauma : experiences of a level 1 trauma center and an assessment of the International Classification Injury Severity Score (ICISS). / Allen, Casey J.; Wagenaar, Amy E.; Horkan, Davis B.; Baldor, Daniel J.; Hannay, William M.; Tashiro, Jun; Namias, Nicholas; Sola, Juan E.

In: Pediatric Surgery International, Vol. 32, No. 7, 01.07.2016, p. 657-663.

Research output: Contribution to journalArticle

Allen, Casey J. ; Wagenaar, Amy E. ; Horkan, Davis B. ; Baldor, Daniel J. ; Hannay, William M. ; Tashiro, Jun ; Namias, Nicholas ; Sola, Juan E. / Predictors of mortality in pediatric trauma : experiences of a level 1 trauma center and an assessment of the International Classification Injury Severity Score (ICISS). In: Pediatric Surgery International. 2016 ; Vol. 32, No. 7. pp. 657-663.
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abstract = "Objectives: Injury severity scoring tools allow systematic comparison of outcomes in trauma research and quality improvement by indexing an expected mortality risk for certain injuries. This study investigated the predictive value of the empirically derived ICD9-derived Injury Severity Score (ICISS) compared to expert consensus-derived scoring systems for trauma mortality in a pediatric population. Methods: 1935 consecutive trauma patients aged <18 years from 1/2000 to 12/2012 were reviewed. Mechanism of injury (MOI), Injury Severity Score (ISS), Revised Trauma Score (RTS), Trauma Score ISS (TRISS), and ICISS were compared using univariate and multivariate logistic regression analysis and receiver operator characteristic analysis. Results: The population was a median age of 11 ± 6 year, 70 {\%} male, and 76 {\%} blunt injury. Median ISS 13 ± 12 and overall mortality 3.5 {\%}. Independent predictors of mortality were initial hematocrit [odds ratio (OR) 0.83 (0.73–0.95)], HCO3 [OR 0.82 (0.67–0.98)], Glasgow Coma Scale score [OR 0.75 (0.62–0.90)], and ISS [OR 1.10 (1.04–1.15)]. TRISS was superior to ICISS in predicting survival [area under receiver operator curve: 0.992 (0.982–1.000) vs 0.888 (0.838–0.938)]. Conclusions: ICISS was inferior to existing injury scoring tools at predicting mortality in pediatric trauma patients.",
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AU - Horkan, Davis B.

AU - Baldor, Daniel J.

AU - Hannay, William M.

AU - Tashiro, Jun

AU - Namias, Nicholas

AU - Sola, Juan E

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N2 - Objectives: Injury severity scoring tools allow systematic comparison of outcomes in trauma research and quality improvement by indexing an expected mortality risk for certain injuries. This study investigated the predictive value of the empirically derived ICD9-derived Injury Severity Score (ICISS) compared to expert consensus-derived scoring systems for trauma mortality in a pediatric population. Methods: 1935 consecutive trauma patients aged <18 years from 1/2000 to 12/2012 were reviewed. Mechanism of injury (MOI), Injury Severity Score (ISS), Revised Trauma Score (RTS), Trauma Score ISS (TRISS), and ICISS were compared using univariate and multivariate logistic regression analysis and receiver operator characteristic analysis. Results: The population was a median age of 11 ± 6 year, 70 % male, and 76 % blunt injury. Median ISS 13 ± 12 and overall mortality 3.5 %. Independent predictors of mortality were initial hematocrit [odds ratio (OR) 0.83 (0.73–0.95)], HCO3 [OR 0.82 (0.67–0.98)], Glasgow Coma Scale score [OR 0.75 (0.62–0.90)], and ISS [OR 1.10 (1.04–1.15)]. TRISS was superior to ICISS in predicting survival [area under receiver operator curve: 0.992 (0.982–1.000) vs 0.888 (0.838–0.938)]. Conclusions: ICISS was inferior to existing injury scoring tools at predicting mortality in pediatric trauma patients.

AB - Objectives: Injury severity scoring tools allow systematic comparison of outcomes in trauma research and quality improvement by indexing an expected mortality risk for certain injuries. This study investigated the predictive value of the empirically derived ICD9-derived Injury Severity Score (ICISS) compared to expert consensus-derived scoring systems for trauma mortality in a pediatric population. Methods: 1935 consecutive trauma patients aged <18 years from 1/2000 to 12/2012 were reviewed. Mechanism of injury (MOI), Injury Severity Score (ISS), Revised Trauma Score (RTS), Trauma Score ISS (TRISS), and ICISS were compared using univariate and multivariate logistic regression analysis and receiver operator characteristic analysis. Results: The population was a median age of 11 ± 6 year, 70 % male, and 76 % blunt injury. Median ISS 13 ± 12 and overall mortality 3.5 %. Independent predictors of mortality were initial hematocrit [odds ratio (OR) 0.83 (0.73–0.95)], HCO3 [OR 0.82 (0.67–0.98)], Glasgow Coma Scale score [OR 0.75 (0.62–0.90)], and ISS [OR 1.10 (1.04–1.15)]. TRISS was superior to ICISS in predicting survival [area under receiver operator curve: 0.992 (0.982–1.000) vs 0.888 (0.838–0.938)]. Conclusions: ICISS was inferior to existing injury scoring tools at predicting mortality in pediatric trauma patients.

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