Toida Chiaki, Muguruma Takashi, Gakumazawa Masayasu, Shinohara Mafumi, Abe Takeru, Takeuchi Ichiro
Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo 173-8606, Japan.
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama 232-0024, Japan.
Children (Basel). 2023 Sep 12;10(9):1542. doi: 10.3390/children10091542.
To date, there is no clinically useful prediction model that is suitable for Japanese pediatric trauma patients. Herein, this study aimed to developed a model for predicting the survival of Japanese pediatric patients with blunt trauma and compare its validity with that of the conventional TRISS model. Patients registered in the Japan Trauma Data Bank were grouped into a derivation cohort (2009-2013) and validation cohort (2014-2018). Logistic regression analysis was performed using the derivation dataset to establish prediction models using age, injury severity, and physiology. The validity of the modified model was evaluated by the area under the receiver operating characteristic curve (AUC). Among 11 predictor models, Model 1 and Model 11 had the best performance (AUC = 0.980). The AUC of all models was lower in patients with survival probability Ps < 0.5 than in patients with Ps ≥ 0.5. The AUC of all models was lower in neonates/infants than in other age categories. Model 11 also had the best performance (AUC = 0.762 and 0.909, respectively) in patients with Ps < 0.5 and neonates/infants. The predictive ability of the newly modified models was not superior to that of the current TRISS model. Our results may be useful to develop a highly accurate prediction model based on the new predictive variables and cutoff values associated with the survival mortality of injured Japanese pediatric patients who are younger and more severely injured by using a nationwide dataset with fewer missing data and added valuables, which can be used to evaluate the age-related physiological and anatomical severity of injured patients.
迄今为止，尚无适用于日本儿科创伤患者的临床实用预测模型。在此，本研究旨在开发一种预测日本钝性创伤儿科患者生存情况的模型，并将其有效性与传统的TRISS模型进行比较。在日本创伤数据库中登记的患者被分为推导队列（2009 - 2013年）和验证队列（2014 - 2018年）。使用推导数据集进行逻辑回归分析，以建立使用年龄、损伤严重程度和生理指标的预测模型。通过受试者操作特征曲线下面积（AUC）评估改良模型的有效性。在11个预测模型中，模型1和模型11表现最佳（AUC = 0.980）。生存概率Ps < 0.5的患者中所有模型的AUC低于Ps≥0.5的患者。所有模型的AUC在新生儿/婴儿中低于其他年龄组。模型11在Ps < 0.5的患者和新生儿/婴儿中也分别表现最佳（AUC = 0.762和0.909）。新改良模型的预测能力并不优于当前的TRISS模型。我们的结果可能有助于基于新的预测变量和与受伤日本儿科患者生存死亡率相关的临界值开发高度准确的预测模型，这些患者年龄更小且损伤更严重，通过使用缺失数据较少且有附加价值的全国性数据集，可用于评估受伤患者与年龄相关的生理和解剖严重程度。
