Medical College of Wisconsin, Milwaukee, WI, USA.
Baylor University Medical Center.
J Pediatr Surg. 2014 Jan;49(1):189-92; discussions 192. doi: 10.1016/j.jpedsurg.2013.09.055. Epub 2013 Oct 5.
BACKGROUND/PURPOSE: Researchers are constantly challenged to identify optimal mortality risk adjustment methodologies that perform accurately in pediatric trauma patients. This study evaluated the new Trauma Mortality Prediction Model (TMPM-ICD-9) in pediatric trauma patients.
Data were analyzed on 107,104 pediatric trauma patients included in the NTDB® in 2010 who had both a valid ISS and probability of death using TMPM-ICD-9. Discrimination was compared using the area under the receiver operator characteristic curve (AUC) and by age, blunt vs penetrating, intent, Glasgow Coma Scale (GCS), and number of injuries.
The AUC for TMPM-ICD-9 demonstrated excellent discrimination in predicting mortality versus ISS overall, 11 to 17years of age (0.96 vs 0.93), by injury type, intent, and in the lowest GCS scores. The TMPM-ICD-9 showed superior discrimination over ISS in patients with more than two injuries.
The TMPM demonstrated superior discrimination compared to ISS. The TMPM shows promise of a much needed and simple to use risk adjustment tool with application to both adult and pediatric patients. Researchers should continue to validate this tool in robust pediatric data sets.
背景/目的：研究人员不断面临挑战，需要寻找在儿科创伤患者中表现准确的最佳死亡率风险调整方法。本研究评估了新的创伤死亡率预测模型（TMPM-ICD-9）在儿科创伤患者中的应用。
对 2010 年纳入 NTDB®的 107,104 例具有有效 ISS 和 TMPM-ICD-9 死亡概率的儿科创伤患者的数据进行了分析。使用受试者工作特征曲线下面积（AUC）比较区分度，并按年龄、钝器伤与穿透伤、意图、格拉斯哥昏迷评分（GCS）和损伤数量进行分层。
TMPM-ICD-9 对死亡率与 ISS 的总体预测具有出色的区分度，在 11 至 17 岁（0.96 对 0.93）、按损伤类型、意图和最低 GCS 评分分层时，AUC 均优于 ISS。TMPM-ICD-9 在损伤数量大于 2 个的患者中具有优于 ISS 的区分度。
TMPM 与 ISS 相比具有更高的区分度。TMPM 有望成为一种非常需要的简单易用的风险调整工具，适用于成人和儿科患者。研究人员应继续在强大的儿科数据集上验证该工具。
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