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The Intensive Care Unit Risk Ratio (ICU-RR): Working Towards A Better Metric To Quantify Burden Of Disease In Pediatric Trauma
*Christopher Snyder1, David Ciesla2, Nicole Chandler1, Raquel Gonzalez1, Paul Danielson1, Kristin Partain3, Nicholas Poulos4, Pam Pieper5, *Joseph Tepas5, Etienne Pracht2
1Johns Hopkins All Children's Hospital, Saint Petersburg, FL;2University of South Florida, Tampa, FL;3Mayo Clinic College of Medicine, Jacksonville, FL;4Nemours Children's Specialty Care, Wolfson Children's Hospital, Jacksonville, FL;5Wolfson Children's Hospital, Jacksonville, FL

Background: Accurately quantifying pediatric trauma disease burden has been challenging. Current metrics tend to be derived from adult trauma populations and focus on probability of survival, which may underestimate disease burden in injured children.
Methods: Patients designated as trauma alerts, admitted to any hospital in Florida in 2017, were obtained from the state Agency for Healthcare Administration database and divided into three age groups: pediatric (0-15 years), non-elderly adult (16-64 years), and elderly (65-84 years). International Classification of Disease (ICD) Injury Severity Scores (ICISS) were calculated from the five years of data preceding the analysis year, quantifying the risk of death. A novel additional measure (ICU-RR) was calculated in similar fashion, utilizing ICD-10 risk ratios to quantify the risk of intensive care unit admission. The distributions of these measures, which range from 0-100 with increasing values indicating greater risk, were compared across age groups using Kruskal-Wallis tests. Results: The analysis included 1,339 pediatric, 15,087 adult, and 4,620 elderly patients. The median ICISS was 4.0 for pediatric, 13.0 for adult, and 14.7 for elderly patients (p<0.001 for comparison of all groups). The median ICU-RR was 71.9 for pediatric, 71.7 for adult, and 72.4 for elderly patients (p=0.93 for pediatric vs. adult and elderly). Conclusions: Although injured children had significantly lower risk of death than adults, their risk for ICU admission was nearly identical to adults in this large population-based cohort. The ICU-RR is easily calculated from available administrative datasets and may provide a more complete measure of pediatric trauma disease burden than survival-based measures.


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