Department of Surgery, University of California, Irvine, Orange, CA, USA.
Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA.
World J Surg. 2023 Nov;47(11):2925-2931. doi: 10.1007/s00268-023-07141-y. Epub 2023 Aug 31.
No widely used stratification tool exists to predict which pediatric trauma patients may require a video-assisted thoracoscopic surgery (VATS). We sought to develop a novel VATS-In-Pediatrics (VIP) score to predict the need for early VATS (within 72 h of admission) for pediatric trauma patients.
The pediatric 2017-2020 Trauma Quality Improvement Program database was used and divided into two sets (derivation set using 2017-2019 data and validation set using 2020 data). First, multiple logistic regression models were created to determine the risk of early VATS for patients ≤ 17 years old. Second, the weighted average and relative impact of each independent predictor were used to derive a VIP score. We then validated the score using the area under the receiver operating characteristic (AROC) curve.
From 218,628 patients in the derivation set, 2183 (1.0%) underwent early VATS. A total of 8 independent predictors of VATS were identified, and the VIP score was derived with scores ranging from 0 to 9. The AROC for this was 0.91. The VATS rate increased steadily from 12.5 to 32% then 60.5% at scores of 3, 4, and 6, respectively. In the validation set, from 70,316 patients, 887 (1.3%) underwent VATS, and the AROC was 0.91.
VIP is a novel and validated scoring tool to predict the need for early VATS in pediatric trauma. This tool can potentially help hospital systems prepare for pediatric patients at high risk for requiring VATS during their first 72 h of admission. Future prospective research is needed to evaluate VIP as a tool that can improve clinical outcomes.
目前尚无广泛使用的分层工具来预测哪些儿科创伤患者可能需要胸腔镜手术（VATS）。我们试图开发一种新的 VATS-in-Pediatrics（VIP）评分系统，以预测儿科创伤患者早期 VATS（入院后 72 小时内）的需求。
使用 2017-2020 年儿科创伤质量改进计划数据库，并将其分为两组（使用 2017-2019 年数据的推导集和使用 2020 年数据的验证集）。首先，建立多元逻辑回归模型，以确定≤17 岁患者早期 VATS 的风险。其次，使用加权平均值和每个独立预测因子的相对影响来推导 VIP 评分。然后，使用接受者操作特征（ROC）曲线下的面积（AUC）来验证该评分。
从推导集中的 218628 例患者中，有 2183 例（1.0%）接受了早期 VATS。确定了 8 个 VATS 的独立预测因子，并得出 VIP 评分，评分范围为 0 至 9。该评分的 AUC 为 0.91。VATS 率从 12.5%稳步上升至 32%，然后在 3、4 和 6 分分别上升至 60.5%。在验证集中，从 70316 例患者中，有 887 例（1.3%）接受了 VATS，AUC 为 0.91。
VIP 是一种新的经过验证的评分工具，可预测儿科创伤患者早期 VATS 的需求。该工具可帮助医院系统为入院后前 72 小时内需要 VATS 的高危儿科患者做好准备。未来需要前瞻性研究来评估 VIP 作为一种可以改善临床结果的工具。
