The value of the injury severity score in pediatric trauma: Time for a new definition of severe injury?
The value of the injury severity score in pediatric trauma: Time for a new definition of severe injury?
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DOI：
10.1097/ta.0000000000001440
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发表时间：
2017-06-01
影响因子：
3.4
通讯作者：
Gaines, Barbara A.
中科院分区：
文献类型：
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作者：
Brown, Joshua B.;Gestring, Mark L.;Gaines, Barbara A.
背景：创伤严重程度评分(ISS)是创伤研究和基准测试中最常用的损伤评分系统。ISS大于15通常定义为严重损伤；然而，没有研究评估ISS在成人和儿童之间的表现是否相似。我们的目标是评估ISS和简明创伤评分(AIS)以预测死亡率，并确定儿童创伤中严重损伤的最佳阈值。方法：纳入2000-2013年宾夕法尼亚州创伤登记的患者。儿童被定义为16岁以下。Logistic回归预测儿童和成人的ISS死亡率。确定了使诊断特征最大化的儿童死亡率的最佳ISS临界值。回归分析还评估了死亡率与每个身体区域最大AIS之间的关系，控制了年龄、机制和非意外创伤。对单系统损伤和多系统损伤进行分析。结果：共纳入352,127名成人和50,579名儿童。儿童在国际空间站的预期死亡率为25岁，与成人在国际空间站的预期死亡率为15人(5%)相似。儿童ISS的最佳临界值为ISS>25，其阳性预测值为19%，阴性预测值为99%，而ISS>15预测死亡率的阳性预测值为7%，阴性预测值为99%。在单一系统损伤的儿童中，死亡率与头部(优势比，4.80；95%可信区间，2.61-8.84；p<；0.01)和胸部AIS(优势比，3.55；95%可信区间，1.81-6.97；p<；0.01)有关，但与腹部、面部、颈部、脊柱或四肢AIS无关(p>；0.05)。对于多系统损伤，除四肢外，所有身体部位AIS评分均与死亡率相关。敏感性分析显示，ISS>23预测需要完全激活创伤，ISS>26是预测功能独立性受损的最佳阈值。结论：ISS>25可能是更合适的儿童严重创伤定义。损伤类型很重要，因为在单一系统损伤的儿童中，只有头部和胸部损伤才会导致死亡。这些发现应该在基准和绩效改进工作中得到考虑。版权所有(C)2017 Wolters KluwerHealth，Inc.保留所有权利。
BACKGROUND: The Injury Severity Score (ISS) is the most commonly used injury scoring system in trauma research and benchmarking. An ISS greater than 15 conventionally defines severe injury; however, no studies evaluate whether ISS performs similarly between adults and children. Our objective was to evaluate ISS and Abbreviated Injury Scale (AIS) to predict mortality and define optimal thresholds of severe injury in pediatric trauma.METHODS: Patients from the Pennsylvania trauma registry 2000-2013 were included. Children were defined as younger than 16 years. Logistic regression predicted mortality from ISS for children and adults. The optimal ISS cutoff for mortality that maximized diagnostic characteristics was determined in children. Regression also evaluated the association between mortality and maximum AIS in each body region, controlling for age, mechanism, and nonaccidental trauma. Analysis was performed in single and multisystem injuries. Sensitivity analyses with alternative outcomes were performed.RESULTS: Included were 352,127 adults and 50,579 children. Children had similar predicted mortality at ISS of 25 as adults at ISS of 15 (5%). The optimal ISS cutoff in children was ISS greater than 25 and had a positive predictive value of 19% and negative predictive value of 99% compared to a positive predictive value of 7% and negative predictive value of 99% for ISS greater than 15 to predictmortality. In single-system-injured children, mortality was associated with head (odds ratio, 4.80; 95% confidence interval, 2.61-8.84; p < 0.01) and chest AIS (odds ratio, 3.55; 95% confidence interval, 1.81-6.97; p < 0.01), but not abdomen, face, neck, spine, or extremity AIS (p > 0.05). For multisystem injury, all body region AIS scores were associated with mortality except extremities. Sensitivity analysis demonstrated ISS greater than 23 to predict need for full trauma activation, and ISS greater than 26 to predict impaired functional independence were optimal thresholds.CONCLUSION: An ISS greater than 25 may be a more appropriate definition of severe injury in children. Pattern of injury is important, as only head and chest injury drive mortality in single-system-injured children. These findings should be considered in benchmarking and performance improvement efforts. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.