新型创伤综合评分比损伤严重程度评分更能可靠地预测儿科创伤患者的死亡率。
Novel Trauma Composite Score is a more reliable predictor of mortality than Injury Severity Score in pediatric trauma.
机构信息
From the Department of Surgery (R.C.K., D.A.H., T.L.Z., J.T.C., K.L.W., M.B.S.), Section of Trauma and Acute Care Surgery (D.A.H., T.L.Z., J.T.C., K.L.W.), University of Chicago Medicine, Chicago, Illinois; Emory School of Medicine (H.B.), Atlanta, Georgia; Department of Surgery (J.C.), Dartmouth-Hitchcock, Lebanon, New Hampshire; and Section of Pediatric Surgery (M.B.S.), Comer Children's Hospital, University of Chicago Medicine, Chicago, Illinois.
出版信息
J Trauma Acute Care Surg. 2021 Oct 1;91(4):599-604. doi: 10.1097/TA.0000000000003235.
BACKGROUND
The equivalent Injury Severity Score (ISS) cutoffs for severe trauma vary between adult (ISS, >16) and pediatric (ISS, >25) trauma. We hypothesized that a novel injury severity prediction model incorporating age and mechanism of injury would outperform standard ISS cutoffs.
METHODS
The 2010 to 2016 National Trauma Data Bank was queried for pediatric trauma patients. Cut point analysis was used to determine the optimal ISS for predicting mortality for age and mechanism of injury. Linear discriminant analysis was implemented to determine prediction accuracy, based on area under the curve (AUC), of ISS cutoff of 25 (ISS, 25), shock index pediatric adjusted (SIPA), an age-adjusted ISS/abbreviated Trauma Composite Score (aTCS), and our novel Trauma Composite Score (TCS) in blunt trauma. The TCS consisted of significant variables (Abbreviated Injury Scale, Glasgow Coma Scale, sex, and SIPA) selected a priori for each age.
RESULTS
There were 109,459 blunt trauma and 9,292 penetrating trauma patients studied. There was a significant difference in ISS (blunt trauma, 9.3 ± 8.0 vs. penetrating trauma, 8.0 ± 8.6; p < 0.01) and mortality (blunt trauma, 0.7% vs. penetrating trauma, 2.7%; p < 0.01). Analysis of the entire cohort revealed an optimal ISS cut point of 25 (AUC, 0.95; sensitivity, 0.86; specificity, 0.95); however, the optimal ISS ranged from 18 to 25 when evaluated by age and mechanism. Linear discriminant analysis model AUCs varied significantly for each injury metric when assessed for blunt trauma and penetrating trauma (penetrating trauma-adjusted ISS, 0.94 ± 0.02 vs. ISS 25, 0.88 ± 0.02 vs. SIPA, 0.62 ± 0.03; p < 0.001; blunt trauma-adjusted ISS, 0.96 ± 0.01 vs. ISS 25, 0.89 ± 0.02 vs. SIPA, 0.70 ± 0.02; p < 0.001). When injury metrics were assessed across age groups in blunt trauma, TCS and aTCS performed the best.
CONCLUSION
Current use of ISS in pediatric trauma may not accurately reflect injury severity. The TCS and aTCS incorporate both age and mechanism and outperform standard metrics in mortality prediction in blunt trauma.
LEVEL OF EVIDENCE
Retrospective review, level IV.
背景
成人（ISS＞16）和儿科（ISS＞25）创伤的严重创伤的等效损伤严重程度评分（ISS）截止值不同。我们假设，一种新的损伤严重程度预测模型，纳入年龄和损伤机制，将优于标准的 ISS 截止值。
方法
2010 年至 2016 年全国创伤数据库对儿科创伤患者进行了查询。使用切点分析确定预测死亡率的最佳 ISS 年龄和损伤机制。基于曲线下面积（AUC），使用线性判别分析确定 ISS 截止值 25（ISS 25）、小儿调整的休克指数（SIPA）、年龄调整的 ISS/简化创伤综合评分（aTCS）和我们新的创伤综合评分（TCS）在钝性创伤中的预测准确性。TCS 由每个年龄预先选择的显著变量（简明损伤评分、格拉斯哥昏迷评分、性别和 SIPA）组成。
结果
共研究了 109459 例钝性创伤和 9292 例穿透性创伤患者。ISS（钝性创伤，9.3±8.0 比穿透性创伤，8.0±8.6；p＜0.01）和死亡率（钝性创伤，0.7%比穿透性创伤，2.7%；p＜0.01）有显著差异。对整个队列的分析显示，ISS 最佳截止值为 25（AUC，0.95；敏感性，0.86；特异性，0.95）；然而，当按年龄和机制评估时，ISS 最佳截止值范围为 18 至 25。线性判别分析模型 AUC 在评估钝性创伤和穿透性创伤时，每个损伤指标差异显著（穿透性创伤调整的 ISS，0.94±0.02 比 ISS 25，0.88±0.02 比 SIPA，0.62±0.03；p＜0.001；钝性创伤调整的 ISS，0.96±0.01 比 ISS 25，0.89±0.02 比 SIPA，0.70±0.02；p＜0.001）。当在钝性创伤中按年龄组评估损伤指标时，TCS 和 aTCS 的表现最佳。
结论
目前在儿科创伤中使用的 ISS 可能无法准确反映损伤严重程度。TCS 和 aTCS 同时考虑年龄和机制，在预测钝性创伤死亡率方面优于标准指标。
证据水平
回顾性研究，IV 级。
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