Katie E Neumayer1, Jill Sweney2, Stephen J Fenton3, Heather T Keenan4, Brian F Flaherty5. 1. Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. Electronic address: katieneumayer@gmail.com. 2. Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. Electronic address: jill.sweney@hsc.utah.edu. 3. Division of Pediatric of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA. Electronic address: stephen.fenton@hsc.utah.edu. 4. Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. Electronic address: heather.keenan@hsc.utah.edu. 5. Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. Electronic address: brian.flaherty@hsc.utah.edu.
Abstract
BACKGROUND: The Children's Intracranial Injury Decision Aid (CHIIDA) was developed to predict which patients with complicated mild traumatic brain injury (cmTBI; GCS ≥13 with depressed skull fracture or intracranial injury) would achieve the composite outcome of neurosurgical intervention, intubation >24 h, or death. The study also explored the CHIIDA as a triage tool to determine need for PICU care. The purpose of this study is to externally validate the CHIIDA and assess its effects on PICU triage. METHODS: Retrospective cohort study (January 2016 to December 2017) to validate the CHIIDA to predict the composite outcome and assess its effects as a PICU triage tool at a level 1 pediatric trauma center. RESULTS: Of 345 patients with cmTBI, the composite outcome occurred in 16 patients (4.6%). At a cutoff score of 2, the CHIIDA predicted the composite outcome with a sensitivity of 94% (95% CI 67-99%) and specificity of 69% (95% CI 64-74%), similar to the original study. Using the same cutoff score for PICU triage resulted in 48 (71%) more patients admitted to PICU. CONCLUSIONS: In our cohort, the CHIIDA predicted the composite outcome well. If applied as a triage tool, it would have resulted in increased unnecessary PICU admissions. LEVEL OF EVIDENCE: Level III, prognosis. Published by Elsevier Inc.
BACKGROUND: The Children's Intracranial Injury Decision Aid (CHIIDA) was developed to predict which patients with complicated mild traumatic brain injury (cmTBI; GCS ≥13 with depressed skull fracture or intracranial injury) would achieve the composite outcome of neurosurgical intervention, intubation >24 h, or death. The study also explored the CHIIDA as a triage tool to determine need for PICU care. The purpose of this study is to externally validate the CHIIDA and assess its effects on PICU triage. METHODS: Retrospective cohort study (January 2016 to December 2017) to validate the CHIIDA to predict the composite outcome and assess its effects as a PICU triage tool at a level 1 pediatric trauma center. RESULTS: Of 345 patients with cmTBI, the composite outcome occurred in 16 patients (4.6%). At a cutoff score of 2, the CHIIDA predicted the composite outcome with a sensitivity of 94% (95% CI 67-99%) and specificity of 69% (95% CI 64-74%), similar to the original study. Using the same cutoff score for PICU triage resulted in 48 (71%) more patients admitted to PICU. CONCLUSIONS: In our cohort, the CHIIDA predicted the composite outcome well. If applied as a triage tool, it would have resulted in increased unnecessary PICU admissions. LEVEL OF EVIDENCE: Level III, prognosis. Published by Elsevier Inc.
Authors: Jacob K Greenberg; Ayodamola Otun; Pyi Theim Kyaw; Christopher R Carpenter; Ross C Brownson; Nathan Kuppermann; David D Limbrick; Randi E Foraker; Po-Yin Yen Journal: Appl Clin Inform Date: 2022-04-27 Impact factor: 2.342