Abstract
Introduction The purpose of this study was to examine the capacity of commonly used trauma scoring systems such as the Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) to predict outcomes in young children with traumatic injuries. Methods This retrospective study was conducted for the period from 2009 to 2016 in Kaohsiung Chang Gung Memorial Medical Hospital, a level I trauma center. We included all children under the age of 6 years admitted to the hospital via the emergency department with any traumatic injury and compared the trauma scores of GCS, ISS, and RTS on patients' outcome. The primary outcomes were mortality and prolonged Intensive Care Unit (ICU) stay, with the latter defined as an ICU stay longer than 14 days. The secondary outcome was the hospital length of stay (HLOS). Receiver operating characteristic (ROC) analysis was also adopted with the value of the area under the ROC curve (AUC) for comparing trauma score prediction with patient mortality. Cutoff values from each trauma score for mortality prediction were also measured by determining the point along the ROC curve where Youden's index was maximum. Results We included a total of 938 patients in this study, with a mean age of 3.1 ± 1.82 years. The mortality rate was 0.9%, and 93 (9.9%) patients had a prolonged ICU stay. An elevated ISS (34 ± 19.9 vs. 5 ± 5.1, p=0.004), lower GCS (8 ± 5.0 vs. 15 ± 1.3, p=0.006), and lower RTS (5.58 ± 1.498 vs. 7.64 ± 0.640, p=0.006) were all associated with mortality. All three scores were considered to be independent risk factors of mortality and prolonged ICU stay and had a linear correlation with increased HLOS. With regard to predicting mortality, ISS has the highest AUC value (ISS: 0.975; GCS: 0.864; and RTS: 0.899). The prediction cutoff values of ISS, GCS, and RTS on mortality were 15, 11, and 7, respectively. Conclusion Regarding traumatic injuries in young children, worse ISS, GCS, and RTS were all associated with increased mortality, prolonged ICU stay, and longer hospital LOS. Of these scoring systems, ISS was the best at predicting mortality.
Highlights
Trauma is considered a big threat to childhood survival. e National Center for Health Statistics in the UnitedStates has indicated that unintentional injury is the leading cause of death and disability in children [1]
We aimed to investigate several commonly used traumatic scores on the outcomes of young children, including mortality, prolonged Intensive Care Unit (ICU) stay, and hospital length of stay (HLOS)
Upon calculating the area under the ROC curve (AUC) value (Table 4), all trauma scores revealed acceptable prediction ability for mortality (ISS: 0.975, 95% CI: 0.940∼1; Glasgow Coma Scale (GCS): 0.864, 95% CI: 0.682∼1; Revised Trauma Score (RTS): 0.899, 95% CI: 0.759∼1) but not for prolonged ICU stay (ISS: 0.502, 95% CI: 0.384∼0.513; GCS: 0.426, 95% CI: 0.447∼0.572; RTS: 0.578, 95% CI: 0.520∼0.653)
Summary
Trauma is considered a big threat to childhood survival. e National Center for Health Statistics in the United. The impact and causes of trauma can vary considerably among different age groups. Most studies related to trauma assessment have investigated pediatric patients with ages ranging from about 0–18 years [4, 5]. Managing traumatic injury in young children is different from adults as children’s compensatory responses to large numbers of blood loss, hypoxia, severe trauma, and burns differ significantly [6]. Young patients often do not have enough vocabulary, resulting in limited expression, especially for children under two years of age [7, 8]. We aimed to investigate several commonly used traumatic scores on the outcomes of young children, including mortality, prolonged ICU stay, and hospital length of stay (HLOS)
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