Comparison of Scoring Systems for Mortality Prediction in Pediatric Multitrauma Patients

2021 ◽  
Author(s):  
Mehmet Çelegen ◽  
Kübra Çelegen
Keyword(s):  
Injury Severity ◽  
Pediatric Trauma ◽  
Pediatric Intensive Care ◽  
Scoring Systems ◽  
International Normalized Ratio ◽  
Mortality Prediction ◽  
Risk Scores ◽  
Mortality Ratio ◽  
Risk Predictors ◽  
Trauma Score

AbstractThe aim of this study was to compare scoring systems for mortality prediction and determine the threshold values of this 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 females and 65% were males 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.

scholarly journals Mortality prediction using a novel combination of biomarkers in the first day of sepsis in intensive care units

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Junkun Liu ◽  
Chengwen Bai ◽  
Binbin Li ◽  
Aijun Shan ◽  
Fei Shi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Scoring Systems ◽  
Predictive Performance ◽  
Serum Levels ◽  
International Normalized Ratio ◽  
Individual Performance ◽  
Mortality Prediction ◽  
New Combination ◽  
Thrombin Time ◽  
Survivor Group

AbstractEarly identification of infection severity and organ dysfunction is crucial in improving outcomes of patients with sepsis. We aimed to develop a new combination of blood-based biomarkers that can early predict 28-day mortality in patients with sepsis or septic shock. We enrolled 66 patients with sepsis or septic shock and compared 14 blood-based biomarkers in the first 24 h after ICU admission. The serum levels of interleukin-6 (IL-6) (median 217.6 vs. 4809.0 pg/ml, P = 0.001), lactate (median 2.4 vs. 6.3 mmol/L, P = 0.014), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (median 1596.5 vs. 32,905.3 ng/ml, P < 0.001), prothrombin time (PT) (median 15.6 vs. 20.1 s, P = 0.030), activated partial thrombin time (APTT) (median 45.1 vs. 59.0 s, P = 0.026), and international normalized ratio (INR) (median 1.3 vs. 1.8, P < 0.001) were significantly lower in the survivor group. IL-6, NT-proBNP, and INR provided the best individual performance in predicting 28-day mortality of patients with sepsis or septic shock. Furthermore, the combination of these three biomarkers achieved better predictive performance (AUC 0.890, P < 0.001) than conventional scoring systems. In summary, the combination of IL-6, NT-proBNP, and INR may serve as a potential predictor of 28-day mortality in critically ill patients with sepsis or septic shock.

scholarly journals A SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS) AND ORGAN DYSFUNCTION IN CHILDREN WITH ABDOMINAL TRAUMA

2020 ◽  
Vol 24 (2) ◽  
pp. 128-133
Author(s):  
Andrey G. Anastasov ◽  
A. V. Scherbinin
Keyword(s):  
Organ Dysfunction ◽  
Abdominal Trauma ◽  
Injury Severity ◽  
Invasive Mechanical Ventilation ◽  
Pediatric Trauma ◽  
Perioperative Period ◽  
Total Leukocyte Count ◽  
Abdominal Injuries ◽  
Clinical Criteria ◽  
Trauma Score

Introduction. To assess SIRS and organ dysfunction in children with abdominal trauma using generally accepted scales is an actual issue for today. Purpose. To verify clinical criteria for SIRS and organ dysfunction in children with abdominal injuries in the perioperative period. Material and methods. 18 patients, aged 6 -12, with injury of their abdominal organs were treated at the Kusch Pediatric Surgery Clinic ( Republican Children’s Clinical Hospital) in Donetsk in 2014-2019. 11 (61.1%) patients with isolated blunt abdominal trauma and injuries of parenchymal organs were taken into Subgroup 1; 7 (38.9%) patients with open abdominal organ trauma and multiple injuries of internal organs - into Subgroup 2. Assessment of mechanical injury severity and prognosis were made using Pediatric Trauma Score (Tepas J.J., 1985) and Revised Trauma Score (Fitzmaurice L.S. 1997). Shock syndrome gradations were made by the FEAST criteria (Fluid Expansion as Supportive therapy) (2017). Results. Nosological configuration of the injury (closed or open, isolated or multiple) as well as the volume and character of surgical intervention were used for defining SIRS severity in children with abdominal injuries. In the perioperative period, parameters characterizing the degree of disorders of vital organs served as unified criteria of organ dysfunction in children with abdominal trauma. Conclusion. Before surgery, the most informative indexes were: tachypnea RR > 18.0 per min, SpO2/FiO2 < 264, HR > 130.0 beats per min, total leukocyte count > 13.5∙109/L or <4.5∙109/L. In the postoperative period: need in the inotropic support of systolic BP within normal limits, invasive / non-invasive mechanical ventilation, oxygen >50% FiO2 to maintain SpO2> 92%, SpO2 / FiO2<264.

Non-accidental Trauma Injury Patterns and Outcomes: A Single Institutional Experience

2015 ◽  
Vol 81 (9) ◽  
pp. 835-838 ◽  
Author(s):  
Austin Ward ◽  
Joseph A. Iocono ◽  
Samuel Brown ◽  
Phillip Ashley ◽  
John M. Draus
Keyword(s):  
Brain Injuries ◽  
Injury Severity ◽  
Hot Spot ◽  
Demographic Data ◽  
Pediatric Trauma ◽  
Pediatric Intensive Care ◽  
Injury Patterns ◽  
Accidental Trauma ◽  
Trauma Population ◽  
Non Accidental Trauma

Non-accidental trauma (NAT) victims account for a significant percentage of our pediatric trauma population. We sought to better understand the injury patterns and outcomes of NAT victims who were treated at our level I pediatric trauma center. Trauma registry data were used to identify NAT victims between January 2008 and December 2012. Demographic data, injury severity, hospital course, and outcomes were evaluated. One hundred and eighty-eight cases of suspected NAT were identified. Children were mostly male and white. The median age was 1.1 years; the median Injury Severity Score was 9. Traumatic brain injuries, lower extremity fractures, and skull fractures were the most common injuries. Twenty-seven per cent required medical procedures; most were performed by orthopedic surgery. Twenty-four per cent required admission to the pediatric intensive care unit. The median length of stay was two days. The mortality rate was 9.6 per cent. We generated a hot spot map of our catchment area and identified areas of our state where NAT occurs at increased rates. NAT victims sustain significant morbidity and mortality. Due to the severity of injuries, pediatric trauma surgeons should be involved in the evaluation and management of these children. Much work is needed to prevent the death and disability incurred by victims of child abuse.

Evaluation of Injury Severity: Review of the Most Commonly Used System for the Evaluation of Injury Severity in Traumatologic Patients

2003 ◽  
Vol 10 (3) ◽  
pp. 16-19 ◽  
Author(s):  
A Karlbauer ◽  
R Woidke ◽  
A Karlbauer ◽  
R Woidke
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Abbreviated Injury Scale ◽  
Coma Scale ◽  
Advantages And Disadvantages ◽  
Revised Trauma Score ◽  
Golden Standard ◽  
Trauma Score

The most commonly used systems for the evaluation of injury severity in traumatologic patients are presented: Glasgo Coma Scale, Mangled Extremity Severity Score, Revised Trauma Score, Abbreviated Injury Scale, Injury Severity Score, Pediatric Trauma Score. Their advantages and disadvantages are given. At present Injury Severity Score is considered to be a «Golden Standard.

The pediatric trauma score as a predictor of injury severity in the injured child

1987 ◽  
Vol 22 (1) ◽  
pp. 14-18 ◽  
Author(s):  
Joseph J. Tepas ◽  
Daniel L. Mollitt ◽  
James L. Talbert ◽  
Michael Bryant
Keyword(s):  
Injury Severity ◽  
Pediatric Trauma ◽  
Injured Child ◽  
Trauma Score

Scoring acuity hours and costs of nursing for trauma care

1993 ◽  
Vol 2 (6) ◽  
pp. 436-443 ◽  
Author(s):  
AE Bond ◽  
FO Thomas ◽  
RL Menlove ◽  
P MacFarlane ◽  
P Petersen
Keyword(s):  
Resource Utilization ◽  
Injury Severity ◽  
Scoring Systems ◽  
Cost Of Care ◽  
Trauma Patients ◽  
Nursing Educators ◽  
Revised Trauma Score ◽  
Trauma Scoring ◽  
Level I ◽  
Trauma Score

OBJECTIVE: To determine nursing resource utilization (acuity hours and dollars) by trauma patients based on analysis of a nursing acuity system and five trauma scoring systems. METHODS: Retrospective review of 448 trauma patients who required transport by aircraft to a level I trauma center. Values from the institution's automated nursing acuity system were compared with the Glasgow Coma Scale score, trauma score, revised trauma score, CRAMS score and injury severity score to obtain acuity hours and financial cost of care for trauma patients. RESULTS: Consistently, analysis of scores computed by five scoring instruments confirmed that nursing resource utilization is greatest for patients who are severely injured but likely to recover. For example, patients with a trauma score of 1 required 49 (+/- 66) mean acuity hours of care; those with a trauma score of 8 needed 189 (+/- 229) mean acuity hours; and those with a trauma score of 16 used 73 (+/- 120) mean acuity hours. Mean dollar costs were $980 (+/- 1293), $3812 (+/- 4518) and $1492 (+/- 2473), respectively. CONCLUSIONS: Nursing resource utilization can be determined for trauma patients by using an automated nursing acuity system and trauma scoring systems. Data acquired in this way provide a concrete basis for healthcare and reimbursement reform, for administrators who design nursing allocations and for nursing educators who prepare graduates to meet the needs of healthcare consumers.

scholarly journals Comparison of Injury Severity Score, Glasgow Coma Scale, and Revised Trauma Score in Predicting the Mortality and Prolonged ICU Stay of Traumatic Young Children: A Cross-Sectional Retrospective Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Yii-Ting Huang ◽  
Ying-Hsien Huang ◽  
Ching-Hua Hsieh ◽  
Chao-Jui Li ◽  
I-Min Chiu
Keyword(s):  
Retrospective Study ◽  
Young Children ◽  
Glasgow Coma Scale ◽  
Injury Severity ◽  
Scoring Systems ◽  
Traumatic Injuries ◽  
Icu Stay ◽  
Revised Trauma Score ◽  
Prolonged Icu Stay ◽  
Trauma Score

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.

scholarly journals Available Bleeding Scoring Systems Poorly Predict Major Bleeding in the Acute Phase of Pulmonary Embolism

2021 ◽  
Vol 10 (16) ◽  
pp. 3615
Author(s):  
Camille Mathonier ◽  
Nicolas Meneveau ◽  
Matthieu Besutti ◽  
Fiona Ecarnot ◽  
Nicolas Falvo ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Major Bleeding ◽  
Statistical Significance ◽  
Real Life ◽  
Scoring Systems ◽  
International Normalized Ratio ◽  
Risk Scores ◽  
Bleeding Events ◽  
Net Reclassification Improvement ◽  
Acute Pe

We aimed to compare six available bleeding scores, in a real-life cohort, for prediction of major bleeding in the early phase of pulmonary embolism (PE). We recorded in-hospital characteristics of 2754 PE patients in a prospective observational multicenter cohort contributing 18,028 person-days follow-up. The VTE-BLEED (Venous Thrombo-Embolism Bleed), RIETE (Registro informatizado de la enfermedad tromboembólica en España; Computerized Registry of Patients with Venous Thromboembolism), ORBIT (Outcomes Registry for Better Informed Treatment), HEMORR2HAGES (Hepatic or Renal Disease, Ethanol Abuse, Malignancy, Older Age, Reduced Platelet Count or Function, Re-Bleeding, Hypertension, Anemia, Genetic Factors, Excessive Fall Risk and Stroke), ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation), and HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly, Drugs/Alcohol) scores were assessed at baseline. International Society on Thrombosis and Haemostasis (ISTH)-defined bleeding events were independently adjudicated. Accuracy of the overall original 3-level and newly defined optimal 2-level outcome of the scores were evaluated and compared. We observed 82 first early major bleedings (3.0% (95% CI, 2.4–3.7)). The predictive power of bleeding scores was poor (Harrel’s C-index from 0.57 to 0.69). The RIETE score had numerically higher model fit and discrimination capacity but without reaching statistical significance versus the ORBIT, HEMORR2HAGES, and ATRIA scores. The VTE-BLEED and HAS-BLED scores had significantly lower C-index, integrated discrimination improvement, and net reclassification improvement compared to the others. The rate of observed early major bleeding in score-defined low-risk patients was high, between 15% and 34%. Current available scoring systems have insufficient accuracy to predict early major bleeding in patients with acute PE. The development of acute-PE-specific risk scores is needed to optimally target bleeding prevention strategies.

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