PEDIATRIC RISK INDICATOR - AN OBJECTIVE MEASUREMENT OF CHILDHOOD INJURY SEVERITY

Introduction: The Pediatric Risk Index (PRI) uses established measures of physiologic derangement (Pediatric Trauma Score and Glasgow Coma S cale) and anatomic severity (Injury Severity Score) to identify those patients at risk of death, impairment, or extensive resource utilizati on. Methods: The PRI was evaluated by analysis of 5,345 patients enter ed into a multi-institutional pediatric trauma registry during 1993. P RI was calculated for each patient, and its distribution for survivors compared with those of fatalities. Analysis of this distribution iden tified a risk discriminant which was used to compare resulting cohorts by mortality, intensive care unit stay, and discharge impairment as m easured by Functional Independence Measure. To evaluate the PRI's abil ity to identify unexpected outcome the records of 7,319 children injur ed in 1992 were then compared the ''standards'' developed from the 199 3 data. Results: Mortality distribution analysis identified a PRI > 1 as an indication of injury related risk. For mortality, intensive care unit stay, and discharge Functional Independence Measurement, there w as a statistically significant difference (chi(2), p < 0.001) between the at-risk and no-risk populations. Comparison of 1992 experience dem onstrated at least one potentially preventable death. Conclusions: The PRI effectively identifies injured patients at risk for dying, impair ment, or extensive intensive care unit care.