Casey J Allen1, Amy E Wagenaar2, Davis B Horkan2, Daniel J Baldor1, William M Hannay1, Jun Tashiro2, Nicholas Namias1, Juan E Sola3. 1. Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA. 2. Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA. 3. Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA. jsola@med.miami.edu.
Abstract
OBJECTIVES: Injury severity scoring tools allow systematic comparison of outcomes in trauma research and quality improvement by indexing an expected mortality risk for certain injuries. This study investigated the predictive value of the empirically derived ICD9-derived Injury Severity Score (ICISS) compared to expert consensus-derived scoring systems for trauma mortality in a pediatric population. METHODS: 1935 consecutive trauma patients aged <18 years from 1/2000 to 12/2012 were reviewed. Mechanism of injury (MOI), Injury Severity Score (ISS), Revised Trauma Score (RTS), Trauma Score ISS (TRISS), and ICISS were compared using univariate and multivariate logistic regression analysis and receiver operator characteristic analysis. RESULTS: The population was a median age of 11 ± 6 year, 70 % male, and 76 % blunt injury. Median ISS 13 ± 12 and overall mortality 3.5 %. Independent predictors of mortality were initial hematocrit [odds ratio (OR) 0.83 (0.73-0.95)], HCO3 [OR 0.82 (0.67-0.98)], Glasgow Coma Scale score [OR 0.75 (0.62-0.90)], and ISS [OR 1.10 (1.04-1.15)]. TRISS was superior to ICISS in predicting survival [area under receiver operator curve: 0.992 (0.982-1.000) vs 0.888 (0.838-0.938)]. CONCLUSIONS: ICISS was inferior to existing injury scoring tools at predicting mortality in pediatric trauma patients.
OBJECTIVES: Injury severity scoring tools allow systematic comparison of outcomes in trauma research and quality improvement by indexing an expected mortality risk for certain injuries. This study investigated the predictive value of the empirically derived ICD9-derived Injury Severity Score (ICISS) compared to expert consensus-derived scoring systems for trauma mortality in a pediatric population. METHODS: 1935 consecutive traumapatients aged <18 years from 1/2000 to 12/2012 were reviewed. Mechanism of injury (MOI), Injury Severity Score (ISS), Revised Trauma Score (RTS), Trauma Score ISS (TRISS), and ICISS were compared using univariate and multivariate logistic regression analysis and receiver operator characteristic analysis. RESULTS: The population was a median age of 11 ± 6 year, 70 % male, and 76 % blunt injury. Median ISS 13 ± 12 and overall mortality 3.5 %. Independent predictors of mortality were initial hematocrit [odds ratio (OR) 0.83 (0.73-0.95)], HCO3 [OR 0.82 (0.67-0.98)], Glasgow Coma Scale score [OR 0.75 (0.62-0.90)], and ISS [OR 1.10 (1.04-1.15)]. TRISS was superior to ICISS in predicting survival [area under receiver operator curve: 0.992 (0.982-1.000) vs 0.888 (0.838-0.938)]. CONCLUSIONS: ICISS was inferior to existing injury scoring tools at predicting mortality in pediatric traumapatients.
Authors: Casey J Allen; Richard J Straker; Jun Tashiro; Laura F Teisch; Jonathan P Meizoso; Juliet J Ray; Nicholas Namias; Juan E Sola Journal: J Surg Res Date: 2015-02-18 Impact factor: 2.192
Authors: Casey J Allen; Evan J Valle; Chad M Thorson; Anthony R Hogan; Eduardo A Perez; Nicholas Namias; Tanya L Zakrison; Holly L Neville; Juan E Sola Journal: J Pediatr Surg Date: 2014-10-26 Impact factor: 2.545
Authors: Casey J Allen; Jun Tashiro; Evan J Valle; Chad M Thorson; Sherry Shariatmadar; Carl I Schulman; Holly L Neville; Kenneth G Proctor; Juan E Sola Journal: J Pediatr Surg Date: 2014-11-08 Impact factor: 2.545