Etienne St-Louis1, David Bracco2, James Hanley3, Tarek Razek4, Robert Baird5. 1. Department of General Surgery, McGill University Health Centre, Montreal, Canada; Department of Pediatric Surgery, McGill University Health Centre, Montreal, Canada. Electronic address: etienne.st-louis@mail.mcgill.ca. 2. Department of Anesthesia, McGill University Health Centre, Montreal, Canada. 3. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada. 4. Department of General Surgery, McGill University Health Centre, Montreal, Canada. 5. Department of Pediatric Surgery, McGill University Health Centre, Montreal, Canada.
Abstract
BACKGROUND: There is a need for a pediatric trauma outcomes benchmarking model that is adapted for Low-and-Middle-Income Countries (LMICs). We used the National-Trauma-Data-Bank (NTDB) and applied constraints specific to resource-poor environments to develop and validate an LMIC-specific pediatric trauma score. METHODS: We selected a sample of pediatric trauma patients aged 0-14years in the NTDB from 2007 to 2012. Primary outcome was in-hospital death. Logistic regression was used to create the Pediatric Resuscitation and Trauma Outcome (PRESTO) score, which includes only low-tech predictor variables - those easily obtainable at point-of-care. Internal validation was performed using 10-fold cross-validation. External validation compared PRESTO to TRISS using ROC analyses. RESULTS: Among 651,030 patients, there were 64% males. Median age was 7. In-hospital mortality-rate was 1.2%. Mean TRISS predicted mortality was 0.04% (range 0%-43%). Independent predictors included in PRESTO (p<0.01) were age, blood pressure, neurologic status, need for supplemental oxygen, pulse, and oxygen saturation. The sensitivity and specificity of PRESTO were 95.7% and 94.0%. The resulting model had an AUC of 0.98 compared to 0.89 for TRISS. CONCLUSION: PRESTO satisfies the requirements of low-resource settings and is inherently adapted to children, allowing for benchmarking and eventual quality improvement initiatives. Further research is necessary for in-situ validation using prospectively collected LMIC data. LEVEL OF EVIDENCE: Level III - Case-Control (Prognostic) Study.
BACKGROUND: There is a need for a pediatric trauma outcomes benchmarking model that is adapted for Low-and-Middle-Income Countries (LMICs). We used the National-Trauma-Data-Bank (NTDB) and applied constraints specific to resource-poor environments to develop and validate an LMIC-specific pediatric trauma score. METHODS: We selected a sample of pediatric traumapatients aged 0-14years in the NTDB from 2007 to 2012. Primary outcome was in-hospital death. Logistic regression was used to create the Pediatric Resuscitation and Trauma Outcome (PRESTO) score, which includes only low-tech predictor variables - those easily obtainable at point-of-care. Internal validation was performed using 10-fold cross-validation. External validation compared PRESTO to TRISS using ROC analyses. RESULTS: Among 651,030 patients, there were 64% males. Median age was 7. In-hospital mortality-rate was 1.2%. Mean TRISS predicted mortality was 0.04% (range 0%-43%). Independent predictors included in PRESTO (p<0.01) were age, blood pressure, neurologic status, need for supplemental oxygen, pulse, and oxygen saturation. The sensitivity and specificity of PRESTO were 95.7% and 94.0%. The resulting model had an AUC of 0.98 compared to 0.89 for TRISS. CONCLUSION: PRESTO satisfies the requirements of low-resource settings and is inherently adapted to children, allowing for benchmarking and eventual quality improvement initiatives. Further research is necessary for in-situ validation using prospectively collected LMIC data. LEVEL OF EVIDENCE: Level III - Case-Control (Prognostic) Study.