Steven C Mehl1, Megan E Cunningham1, Christian J Streck2, Rowland Pettit1, Eunice Y Huang3, Matthew T Santore4, Kuojen Tsao5, Richard A Falcone6, Melvin S Dassinger7, Jeffrey H Haynes8, Robert T Russell9, Bindi J Naik-Mathuria1, Shawn D St Peter10, David Mooney11, Jeffrey Upperman12, Martin L Blakely13, Adam M Vogel14. 1. Department of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street #1210, Houston, TX, 77030, USA. 2. Medical University of South Carolina Children's Hospital, Charleston, SC, USA. 3. Le Bonheur Children's Hospital, Memphis, TN, USA. 4. Children's Healthcare of Atlanta, Atlanta, GA, USA. 5. Children's Memorial Hermann Hospital, Houston, TX, USA. 6. Cincinnati Children's Hospital, Cincinnati, OH, USA. 7. Arkansas Children's Hospital, Little Rock, AR, USA. 8. Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA. 9. Children's Hospital of Alabama, Birmingham, AL, USA. 10. Children's Mercy Hospital Kansas City, Kansas City, MO, USA. 11. Boston Children's Hospital, Boston, MA, USA. 12. LA Children's Hospital, Los Angeles, CA, USA. 13. Vanderbilt University Medical Center, Nashville, TN, USA. 14. Department of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street #1210, Houston, TX, 77030, USA. amvogel@texaschildrens.org.
Abstract
BACKGROUND: Pediatric trauma patients sustaining blunt abdominal trauma (BAT) with intra-abdominal injury (IAI) are frequently admitted to the intensive care unit (ICU). This study was performed to identify predictors for ICU admission following BAT. METHODS: Prospective study of children (< 16 years) who presented to 14 Level-One Pediatric Trauma Centers following BAT over a 1-year period. Patients were categorized as ICU or non-ICU patients. Data collected included vitals, physical exam findings, laboratory results, imaging, and traumatic injuries. A multivariable hierarchical logistic regression model was used to identify predictors of ICU admission. Predictive ability of the model was assessed via tenfold cross-validated area under the receiver operating characteristic curves (cvAUC). RESULTS: Included were 2,182 children with 21% (n = 463) admitted to the ICU. On univariate analysis, ICU patients were associated with abnormal age-adjusted shock index, increased injury severity scores (ISS), lower Glasgow coma scores (GCS), traumatic brain injury (TBI), and severe solid organ injury (SOI). With multivariable logistic regression, factors associated with ICU admission were severe trauma (ISS > 15), anemia (hematocrit < 30), severe TBI (GCS < 8), cervical spine injury, skull fracture, and severe solid organ injury. The cvAUC for the multivariable model was 0.91 (95% CI 0.88-0.92). CONCLUSION: Severe solid organ injury and traumatic brain injury, in association with multisystem trauma, appear to drive ICU admission in pediatric patients with BAT. These results may inform the design of a trauma bay prediction rule to assist in optimizing ICU resource utilization after BAT. STUDY DESIGN: Prognosis study.
BACKGROUND: Pediatric trauma patients sustaining blunt abdominal trauma (BAT) with intra-abdominal injury (IAI) are frequently admitted to the intensive care unit (ICU). This study was performed to identify predictors for ICU admission following BAT. METHODS: Prospective study of children (< 16 years) who presented to 14 Level-One Pediatric Trauma Centers following BAT over a 1-year period. Patients were categorized as ICU or non-ICU patients. Data collected included vitals, physical exam findings, laboratory results, imaging, and traumatic injuries. A multivariable hierarchical logistic regression model was used to identify predictors of ICU admission. Predictive ability of the model was assessed via tenfold cross-validated area under the receiver operating characteristic curves (cvAUC). RESULTS: Included were 2,182 children with 21% (n = 463) admitted to the ICU. On univariate analysis, ICU patients were associated with abnormal age-adjusted shock index, increased injury severity scores (ISS), lower Glasgow coma scores (GCS), traumatic brain injury (TBI), and severe solid organ injury (SOI). With multivariable logistic regression, factors associated with ICU admission were severe trauma (ISS > 15), anemia (hematocrit < 30), severe TBI (GCS < 8), cervical spine injury, skull fracture, and severe solid organ injury. The cvAUC for the multivariable model was 0.91 (95% CI 0.88-0.92). CONCLUSION: Severe solid organ injury and traumatic brain injury, in association with multisystem trauma, appear to drive ICU admission in pediatric patients with BAT. These results may inform the design of a trauma bay prediction rule to assist in optimizing ICU resource utilization after BAT. STUDY DESIGN: Prognosis study.
Authors: Christian J Streck; Adam M Vogel; Jingwen Zhang; Eunice Y Huang; Matthew T Santore; Kuojen Tsao; Richard A Falcone; Melvin S Dassinger; Robert T Russell; Martin L Blakely Journal: J Am Coll Surg Date: 2017-01-24 Impact factor: 6.113
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