A Comparison of Trauma Scoring Systems Using Pediatric TQIP Data
*Andrew Nordin, Junxin Shi, *Krista Wheeler, Henry Xiang, *Brian Kenney
Nationwide Children's Hospital, Columbus, OH
Several studies have shown that the shock index, pediatric age-adjusted (SIPA) accurately predicts more severe injury and worse outcomes in pediatric trauma patients. However, no studies have compared SIPA against other physiologic trauma scoring systems. We utilized pediatric Trauma Quality Improvement Program (TQIP) data to compare the abilities of the shock index (SI), SIPA and Revised Trauma Score (RTS) to predict outcomes in pediatric trauma patients.
We obtained 2014 TQIP data for pediatric patients 1-16 years old with injury severity scores >15. Data variables included demographics, mechanism of injury, and initial vital signs and Glasgow Coma Score on emergency department arrival. SI and SIPA were calculated as heart rate divided by systolic blood pressure and considered positive if greater than established cutoff values. RTS was calculated as an unweighted sum and considered positive if less than 12. Scores were compared using Student’s t-test or chi-square analysis as appropriate.
We identified 3,254 blunt and 103 penetrating trauma patients. For blunt trauma patients, SIPA and RTS were positive in 801 (24.6%) and 997 (30.6%) patients, respectively. Compared to SIPA, RTS was associated with more severe head injury, longer length of stay (LOS), ICU LOS and rehab transfer; SIPA and RTS outperformed SI for all measured outcomes. In penetrating trauma, RTS held no predictive advantage over either SI or SIPA.
Conclusions (implications for practice):
SIPA compares favorably to RTS in predicting outcomes in pediatric trauma, and its ease of calculation may provide an additional practical advantage over RTS. Future research should compare these scores prospectively.
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