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A Novel Trauma Composite Score is a More Reliable Predictor of Mortality than Injury Severity Score in Pediatric Trauma
Robert Keskey1, David Hampton1, Henry Biermann1, Justin Cirone2, Tanya Zakrison1, Jennifer Cone1, Ken Wilson1, *Mark Slidell1
1University of Chicago, Chicago, IL; 2Dartmouth-Hitchcock Department of Surgery, Lebanon, NH

Background: Injury severity score (ISS) predicted mortality varies between adult (ISS>16) and pediatric (ISS>25) trauma patients.  We hypothesized that a novel ISS prediction mortality model, which accounted for individual ages and mechanism, would outperform standard ISS cutoffs.
Methods: The 2010-2016 NTDB was queried for pediatric trauma patients. Linear discriminant analysis determined the predictive capabilities of: ISS cutoff of 25 (ISS25), age-based ISS, shock index pediatric adjusted (SIPA), and our novel Pediatric Trauma Composite Score (pTCS).  The pTCS consisted of significant variables (AIS, GCS, Gender, and SIPA) selected a priori for each age.  Each model’s area under the curve (AUC) determined their prediction accuracy.  Cut point analysis determined the optimal ISS for predicting mortality.
Results: There were 109,459 blunt (BT) and 9,292 penetrating traumas (PT) studied.  There was a significant difference in median ISS (BT:9 [IQR:4,10] vs. PT:5[IQR:1,10], p<0.01) and mortality (BT:0.7% vs. PT:2.7%, p<0.01).  ISS varied significantly across all ages (ISS:15-25) and the optimal ISS for BT was 22 (AUC:0.95) and 16 for PT (AUC:0.94).  Model AUCs varied significantly (BT - SIPA:0.70 vs. ISS25:0.91 vs. pTCS:0.98, p<0.01; PT – SIPA:0.66 vs. ISS25:0.88 vs. pTCS:0.97, p<0.01). pTCS outperformed all models across all ages (Fig.1).
Conclusions:  The pTCS which incorporates age, mechanism, and AIS, outperforms standard injury metrics in mortality prediction. This may improve injury benchmarking for quality improvement and trauma center validation.


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