Use of out-of-hospital variables to predict severity of injury in pediatric patients involved in motor vehicle crashes.
Use of out-of-hospital variables to predict severity of injury in pediatric patients involved in motor vehicle crashes.
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DOI：
10.1067/mem.2002.123549
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发表时间：
2002-05
影响因子：
6.2
通讯作者：
C. Newgard;Roger J Lewis;Roger J. Lewis;B. Jolly
中科院分区：
文献类型：
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作者：
C. Newgard;Roger J Lewis;Roger J. Lewis;B. Jolly
研究目的：我们试图创建一个临床决策规则，在变量的基础上，提供了医院外的人员，可以用来准确地预测严重损伤的儿科患者参与机动车碰撞的乘员。方法：我们分析了国家汽车抽样系统数据库，一个国家概率样本，使用15岁以下的儿科患者（仅乘员）参与机动车碰撞，从1993年1月至1999年12月。国家汽车抽样系统数据库包括来自全国各地的患者，加权代表全国样本。在分类和回归树分析中使用了12个院外变量，以创建一个将严重损伤儿童（损伤严重度评分[ISS] ≥ 16）与轻微损伤儿童（ISS ≥ 6 in [>或=15 cm]，以及约束使用）区分开来的决策规则，以预测ISS ≥ 16的患者。内部交叉验证用于确定敏感性和特异性，分别为92%和73%，用于预测ISS为16或以上的患者。结论医院外的变量提供给现场人员可以用来有效地分流儿科机动车碰撞患者使用的决策规则在这里开发。需要进行前瞻性试验来检验这一决策规则在实际应用中的作用。
STUDY OBJECTIVE We sought to create a clinical decision rule, on the basis of variables available to out-of-hospital personnel, that could be used to accurately predict severe injury in pediatric patients involved in motor vehicle crashes as occupants. METHODS We analyzed the National Automotive Sampling System database, a national probability sample, using pediatric patients up to 15 years old (occupants only) involved in motor vehicle crashes from January 1993 to December 1999. The National Automotive Sampling System database includes patients from regions throughout the country, weighted to represent a nationwide sample. Twelve out-of-hospital variables were used in classification and regression tree analysis to create a decision rule separating children with severe injuries (Injury Severity Score [ISS] > or =16) from those with minor injuries (ISS or =6 in [> or =15 cm], and restraint use) to predict those patients with an ISS of 16 or more. Internal cross-validation was used to determine the sensitivity and specificity, yielding values of 92% and 73%, respectively, for the prediction of patients with an ISS of 16 or more. CONCLUSION Out-of-hospital variables available to field personnel could be used to effectively triage pediatric motor vehicle crash patients using the decision rule developed here. Prospective trials would be needed to test this decision rule in actual use.