PREDICTIVE FACTORS OF OUTCOME IN SEVERELY TRAUMATIZED CHILDREN

To identify risk factors associated with death in traumatized children , we prospectively studied 507 consecutive patients (7 +/- 4 yr) admit ted to a level I pediatric trauma center over a 3-yr period. Pediatric Trauma Scorn (PTS), Glasgow Coma Scale (GCS) score, and Injury Severi ty Score (ISS) were calculated. Age, injury mechanism, injury pattern, and initial critical care were recorded. Univariate and multivariate analyses were performed for potential risk factors associated with mor tality. Receiver operating characteristic curves were used to determin e threshold values of variables identified by univariate analysis. Mos t children suffered from blunt trauma (99.6%), and head trauma was not ed in 85%. Median values (range) of GCS scores, PTS, and ISS were 10 ( 3-15), 7 (-4 to 12), and 16 (3-75), respectively. The mortality rate w as 12%. Using multivariate analysis, death was significantly associate d with an ISS greater than or equal to 25 (odds ratio [OR] 22.2, 95% c onfidence interval 2.8-174.9), GCS score less than or equal to 7 (OR 4 .77, 1.8-12.7), emergency blood transfusion greater than or equal to 2 0 mL/kg (OR 4.3, 2.1-9.1), and PTS less than or equal to 4 (OR 3.7, 1. 4-9.7). An ISS greater than or equal to 25, GCS score less than or equ al to 7, immediate blood transfusion greater than or equal to 20 mL/kg , and PTS less than or equal to 4 were significant and independent ris k factors of death in an homogenous population of severely injured chi ldren. The probability of traumatic death was therefore 0 (95% confide nce interval 0-0.0135) in children with no one of these threshold valu es in the four predictive factors and 0.63 (95% confidence interval 0. 47-0.76) in those children with all the threshold values. implications : Methods used for evaluating outcome of trauma patients have essentia lly been derived from adult series, and attempts to apply them to chil dren have usually been inaccurate. Univariate and multivariate analyse s were performed to identify risk factors associated with death in sev erely traumatized children, and Receiver operating characteristic curv es were used to determine threshold values.