De Los Ríos-Pérez Ana, García Alberto, Cuello Laura, Rebolledo Sara, Fandiño-Losada Andrés
Program in Methodology of Biomedical Research and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain.
Fundación Valle del Lili University Hospital, Cali, Colombia.
Lancet Reg Health Am. 2022 Jun 29;13:100312. doi: 10.1016/j.lana.2022.100312. eCollection 2022 Sep.
Despite improvements in children's health due to a reduction in infections, trauma continues to cause many deaths among adolescents. Strategies to mitigate morbidity and mortality from trauma include severity scores to classify and refer patients to the appropriate hospitals to provide better management; however, these strategies have not been assessed in Colombian children. This study aimed to describe the characteristics and outcomes of injured children and evaluate the performance of the Pediatric Trauma Score (PTS) in predicting survival at a major trauma centre in a Colombian city.
This was a retrospective cohort study of children aged <18 years who were treated for injuries at a hospital in Colombia. The primary outcome was 30-day mortality. A simple logistic regression model was used with PTS as the predictor variable and vital status at discharge as the outcome variable. PTS performance was assessed by discrimination using the area under the receiver-operating characteristic (AUROC) curve and by calibration using the Hosmer-Lemeshow (HL) goodness-of-fit test.
A total of 1047 children were admitted. The median age was 12 years (interquartile range [IQR]=5-15); 73·7% were male, and 66·1% had blunt trauma. The most frequent cause of injury was traffic accident (31·5%) followed by assaults (29%). Mortality was 5·9%; 61·3% of these deaths occurred in adolescents between 15 and 17 years of age and 71% of deaths in this age group were due to injuries from a firearm. The PTS had a median of 7 (IQR=5-9), an AUROC of 0·93, and good calibration (HL=7·97, = 0·33).
The highest proportion of trauma and death occurred among adolescents. Interpersonal violence was the most frequent cause of death in this age group. The PTS showed good predictive power for survival, with excellent discrimination and good calibration.
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尽管由于感染减少，儿童健康状况有所改善，但创伤仍然是青少年死亡的主要原因。减轻创伤发病率和死亡率的策略包括使用严重程度评分对患者进行分类，并将其转诊至合适的医院以提供更好的治疗；然而，这些策略尚未在哥伦比亚儿童中进行评估。本研究旨在描述受伤儿童的特征和结局，并评估儿童创伤评分（PTS）在哥伦比亚某城市一家主要创伤中心预测生存情况的性能。
这是一项对哥伦比亚一家医院收治的18岁以下受伤儿童进行的回顾性队列研究。主要结局是30天死亡率。使用简单逻辑回归模型，将PTS作为预测变量，出院时的生命状态作为结局变量。通过使用受试者工作特征（AUROC）曲线下面积进行判别以及使用Hosmer-Lemeshow（HL）拟合优度检验进行校准来评估PTS的性能。
共收治1047名儿童。中位年龄为12岁（四分位间距[IQR]=5-15）；73.7%为男性，66.1%为钝性创伤。最常见的受伤原因是交通事故（31.5%），其次是袭击（29%）。死亡率为5.9%；其中61.3%的死亡发生在15至17岁的青少年中，该年龄组71%的死亡是由于枪支伤害。PTS的中位数为7（IQR=5-9），AUROC为0.93，校准良好（HL=7.97，P=0.33）。
创伤和死亡比例最高的是青少年。人际暴力是该年龄组最常见死因。PTS对生存情况显示出良好的预测能力，具有出色的判别能力和良好的校准。
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