Abstract
BackgroundInjury prediction scores facilitate the development of clinical management protocols to decrease mortality. However, most of the previously developed scores are limited in scope and are non-specific for use in children. We aimed to develop and validate a risk prediction model of death for injured and Traumatised Thai children.MethodsOur cross-sectional study included 43,516 injured children from 34 emergency services. A risk prediction model was derived using a logistic regression analysis that included 15 predictors. Model performance was assessed using the concordance statistic (C-statistic) and the observed per expected (O/E) ratio. Internal validation of the model was performed using a 200-repetition bootstrap analysis.ResultsDeath occurred in 1.7% of the injured children (95% confidence interval [95% CI]: 1.57–1.82). Ten predictors (i.e., age, airway intervention, physical injury mechanism, three injured body regions, the Glasgow Coma Scale, and three vital signs) were significantly associated with death. The C-statistic and the O/E ratio were 0.938 (95% CI: 0.929–0.947) and 0.86 (95% CI: 0.70–1.02), respectively. The scoring scheme classified three risk stratifications with respective likelihood ratios of 1.26 (95% CI: 1.25–1.27), 2.45 (95% CI: 2.42–2.52), and 4.72 (95% CI: 4.57–4.88) for low, intermediate, and high risks of death. Internal validation showed good model performance (C-statistic = 0.938, 95% CI: 0.926–0.952) and a small calibration bias of 0.002 (95% CI: 0.0005–0.003).ConclusionsWe developed a simplified Thai pediatric injury death prediction score with satisfactory calibrated and discriminative performance in emergency room settings.
Highlights
Injury prediction scores facilitate the development of clinical management protocols to decrease mortality
We considered for inclusion some variables that are not included in the previously developed scores, but that may be relevant for our clinical setting
The study was organized by the Thai Taskforce of Pediatric Injury, a collaboration between Ramathibodi Hospital (Bangkok), the Bureau of Epidemiology, the Ministry of Public Health (MOPH), and trauma care centers registered with the National Pediatric Injury and Trauma Registry of Thailand (NPIRT)
Summary
Injury prediction scores facilitate the development of clinical management protocols to decrease mortality. Factors associated with survival of injured children include individual characteristics (e.g., age, gender, weight, and underlying diseases), pre-hospital factors (e.g., injury mechanisms, anatomic injured regions, cause of injury, duration of transportation, and quality of first aid), and hospital factors (e.g., trauma center type, trauma care team experience, quality of emergency care, and the patient’s physiologic reserve at arrival). These factors were used to develop clinical prediction scores to predict injury severity and survival probability, and decrease the number of post-injury fatal outcomes. Emergency care personnel use these scores to prioritize proper treatment and management, allocate the trauma center type, physician, and team, and guide decisions about treatment interventions
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