Novel Trauma Composite Score is a more reliable predictor of mortality than Injury Severity Score in pediatric trauma

Keskey, Robert; Hampton, David A.; Biermann, Henry; Cirone, Justin; Zakrison, Tanya L.; Cone, Jennifer; Wilson, Kenneth A.; Slidell, Mark B.

doi:10.1097/ta.0000000000003235

Cited by 4 publications

(10 citation statements)

References 18 publications

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“…This study also showed that the prevalence and in-hospital mortality of severely injured patients aged 55–64, 65–75 and ≥75 years increased stepwise. On the other hand, previous studies suggested that the ISS cut-off of ≥16 in adult patients was equivalent to a cut-off of ≥26 in paediatric patients aged <16 years 14 15. This study showed different results from those of a previous study,15 where the in-hospital mortality of paediatric patients aged 0–4 years with an ISS ≥26 was high (17.7%) and that of paediatric patients aged 5–14 years with an ISS ≥26 was low (10.9%), as shown in figure 2.…”

Section: Discussioncontrasting

confidence: 77%

“…1530 (13) 2106 (15) 3053 (15) 3548 (10) Upper extremity injury with AIS ≥3 6562 (6) 57 (5) 590 (14) 581 ( 5) 522 ( 7) 711 ( 7) 849 (7) 798 (6) 1026 (5) 1428 ( 4)…”

Section: Discussionmentioning

confidence: 99%

“…Lower extremity injury with AIS ≥3 31 526 (27) 124 (11) 634 (16) 2143 (20) 1660 (21) 2055 (21) 2404 (20) 2691 (19) 4358 62 (6) 367 (9) 1595 (15) 1129 (14) 1481 (15) 1823 (15) 2038 (15) 2910 (15) 3938 (11) Data are presented as number (percentage) or median (IQR Q1-Q3). AIS, Abbreviated Injury Scale.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating the definition of severely injured patients: a Japanese nationwide 5-year retrospective study

et al. 2023

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ObjectivesThe definition of severely injured patients lacks universal consensus based on quantitative measures. The most widely used definition of severe injury is based on the Injury Severity Score (ISS), which is calculated using the Abbreviated Injury Scale in Japan. This study aimed to compare the prevalence, in-hospital mortality and OR for mortality in patients with ISS ≥16, ISS ≥18 and ISS ≥26 by age groups.DesignRetrospective cohort study.SettingJapan Trauma Data Bank, which is a nationwide trauma registry with data from 280 hospitals.ParticipantsWe used data of 117 199 injured patients from a national database. We included injured patients who were transferred from the scene of injury by ambulance and/or physician.Primary and secondary outcome measuresPrevalence, in-hospital mortality and OR for mortality with respect to age and injury level (ISS group).ResultsIn all age categories, the in-hospital mortality of patient groups with an ISS ≥16, ISS ≥18 and ISS ≥26 was 13.3%, 17.4% and 23.5%, respectively. The in-hospital mortality for patients aged >75 years was the highest (20% greater than that of the other age groups). Moreover, in-hospital mortality for age group 5–14 years was the lowest (4.0–10.9%). In all the age groups, the OR for mortality for patients with ISS ≥16, ISS ≥18 and ISS ≥26 was 12.8, 11.0 and 8.4, respectively.ConclusionsOur results revealed the lack of an acceptable definition, with a high in-hospital mortality and high OR for mortality for all age groups.

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Section: Discussioncontrasting

confidence: 77%

“…1530 (13) 2106 (15) 3053 (15) 3548 (10) Upper extremity injury with AIS ≥3 6562 (6) 57 (5) 590 (14) 581 ( 5) 522 ( 7) 711 ( 7) 849 (7) 798 (6) 1026 (5) 1428 ( 4)…”

Section: Discussionmentioning

confidence: 99%

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Evaluating the definition of severely injured patients: a Japanese nationwide 5-year retrospective study

et al. 2023

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“…Proposed uses include intensive care unit admission guidelines, 17,18 study inclusion criteria, 25 and risk prediction 21 . It has also been incorporated as one component of multifaceted mortality prediction tools 16,21,26 …”

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confidence: 99%

Derivation and validation of an improved pediatric shock index for predicting need for early intervention and outcomes in pediatric trauma

Georgette

Keskey

Hampton

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Shock index, pediatric age adjusted (SIPA), has been widely applied in pediatric trauma but has limited precision because of the reference ranges used in its derivation. We hypothesized that a pediatric shock index (PSI) equation based on age-based vital signs would outperform SIPA. METHODS:A retrospective cohort of trauma patients aged 1 to 18 years from Trauma Quality Programs -Participant Use File 2010 to 2018 was performed. A random 70% training subset was used to derive Youden index-optimizing shock index (SI) cutoffs by age for blood transfusion within 4 hours. We used linear regression to derive equations representing the PSI cutoff for children 12 years or younger and 13 years or older. For children 13 years or older, the well-established SI of 0.9 remained optimal, consistent with SIPA and other indices. For children 12 years or younger in the 30% validation subset, we compared our age-based PSI to SIPA as predictors of early transfusion, mortality, pediatric intensive care unit admission, and injury severity score of ≥25. For bedside use, a simplified "rapid" pediatric shock index (rPSI) equation was also derived and compared with SIPA. RESULTS:A total of 439,699 patients aged 1 to 12 years met the inclusion criteria with 2,718 (1.3% of those with available outcome data) requiring transfusion within 4 hours of presentation. In the validation set, positive predictive values for early transfusion were higher for PSI (8.3%; 95% confidence interval [CI], 7.5-9.1%) and rPSI (6.3%; 95% CI, 5.7-6.9%) than SIPA (4.3%; 95% CI, 3.9-4.7%). For early transfusion, negative predictive values for both PSI (99.3%; 95% CI, 99.2-99.3%) and rPSI (99.3%; 95% CI, 99.2-99.4%) were similar to SIPA (99.4%; 95% CI, 99.3-99.4%). CONCLUSION:We derived the PSI and rPSI for use in pediatric trauma using empiric, age-based SI cutoffs. The PSI and rPSI achieved higher positive predictive values and similar negative predictive values to SIPA in predicting the need for early blood transfusion and mortality.

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“…We have now demonstrated the failures of universal ISS cutoffs in both adult and pediatric trauma patients. 19 As ISS is a commonly used metric for trauma outcomes research and quality improvement metrics, it is important that we begin to reconsider how injury severity is measured and used among trauma patients. Injury Severity Score has previously been to be an imperfect metric as it does not account for mechanism of injury, age, and presenting physiology.…”

Section: Discussionmentioning

confidence: 99%

Novel Trauma Composite Score is superior to Injury Severity Score in predicting mortality across all ages

Keskey

Slidell

Bohr

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Injury Severity Score (ISS) is a widely used metric for trauma research and center verification; however, it does not account for age-related physiologic parameters. We hypothesized that a novel age-based injury severity metric would better predict mortality. METHODS:Adult patients (≥18 years) sustaining blunt trauma (BT) or penetrating trauma (PT) were abstracted from the 2010 to 2016 National Trauma Data Bank. Admission vitals, Glasgow Coma Scale, ISS, mechanism, and outcomes were analyzed. Patients with incomplete/non-physiologic vital signs were excluded. For each age: (1) a cut point analysis was used to determine the ISS with the highest specificity and sensitivity for predicting mortality and (2) a linear discriminant analysis was performed using ISS, ISS greater than 16, Trauma and Injury Severity Score, and Revised Trauma Scale to compare each scoring system's mortality prediction. A novel injury severity metric, the trauma component score (TCS), was developed for each age using significant (p < 0.05) variables selected from Abbreviated Injury Scale scores, Glasgow Coma Scale, vital signs, and gender. Receiver operator curves were developed and the areas under the curve were compared between the TCS and other systems. RESULTS:There 777,794 patients studied (BT, 91.1%; PT, 8.9%). Blunt trauma patients were older (53.6 ± 21.3 years vs. 34.4 ± 13.8 years), had higher ISS scores (11.1 ± 8.5 vs. 8.5 ± 8.9), and lower mortality (2.9% vs. 3.4%) than PT patients (p < 0.05). When assessing the entire PT and BT cohort the optimal ISS cut point was 16. The optimal ISS was between 20 and 25 for BT younger than 70 years. For those older than 70 years, the optimal BT ISS steadily declined as age increased PT's cut point was 16 or less for all ages assessed. When the injury metrics were compared by area under the curve, our novel TCS more accurately predicted mortality across all ages in both BT and PT (p < 0.001). CONCLUSION:Injury Severity Score is a poor mortality predictor in older patients and those sustaining penetrating trauma. The age-based TCS is a superior metric for mortality prediction across all ages.

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Novel Trauma Composite Score is a more reliable predictor of mortality than Injury Severity Score in pediatric trauma

Cited by 4 publications

References 18 publications

Evaluating the definition of severely injured patients: a Japanese nationwide 5-year retrospective study

Evaluating the definition of severely injured patients: a Japanese nationwide 5-year retrospective study

Derivation and validation of an improved pediatric shock index for predicting need for early intervention and outcomes in pediatric trauma

Novel Trauma Composite Score is superior to Injury Severity Score in predicting mortality across all ages

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