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Predictors of mortality in pediatric trauma: experiences of a level 1 trauma center and an assessment of the International Classification Injury Severity Score (ICISS)

Pediatric Surgery International volume 32, pages 657–663 (2016)Cite this article

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.

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Acknowledgments

We would like to thank Jonathan Andron, who maintains the trauma registry.

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Affiliations

  1. Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

    Casey J. Allen, Daniel J. Baldor, William M. Hannay & Nicholas Namias

  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

    Amy E. Wagenaar, Davis B. Horkan, Jun Tashiro & Juan E. Sola

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  1. Casey J. Allen
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  2. Amy E. Wagenaar
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  3. Davis B. Horkan
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  4. Daniel J. Baldor
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  5. William M. Hannay
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  6. Jun Tashiro
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Correspondence to Juan E. Sola.

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None of the authors have declared conflicts of interest.

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Allen, C.J., Wagenaar, A.E., Horkan, D.B. et al. Predictors of mortality in pediatric trauma: experiences of a level 1 trauma center and an assessment of the International Classification Injury Severity Score (ICISS). Pediatr Surg Int 32, 657–663 (2016). https://doi.org/10.1007/s00383-016-3900-7

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  • DOI: https://doi.org/10.1007/s00383-016-3900-7

Keywords

  • Children
  • Injury
  • Pediatric Trauma
  • ICISS
  • TRISS
  • Mortality
  • Survival
  • Trauma outcomes