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Development and validation of a new pediatric resuscitation and trauma outcome (PRESTO) model using the U.S. National Trauma Data Bank.

Development and validation of a new pediatric resuscitation and trauma outcome (PRESTO) model using the U.S. National Trauma Data Bank.

Authors :
St-Louis E
Bracco D
Hanley J
Razek T
Baird R
Source :
Journal of pediatric surgery [J Pediatr Surg] 2017 Oct 12. Date of Electronic Publication: 2017 Oct 12.
Publication Year :
2017
Publisher :
Ahead of Print

Abstract

Background: There is a need for a pediatric trauma outcomes benchmarking model that is adapted for Low-and-Middle-Income Countries (LMICs). We used the National-Trauma-Data-Bank (NTDB) and applied constraints specific to resource-poor environments to develop and validate an LMIC-specific pediatric trauma score.<br />Methods: We selected a sample of pediatric trauma patients aged 0-14years in the NTDB from 2007 to 2012. Primary outcome was in-hospital death. Logistic regression was used to create the Pediatric Resuscitation and Trauma Outcome (PRESTO) score, which includes only low-tech predictor variables - those easily obtainable at point-of-care. Internal validation was performed using 10-fold cross-validation. External validation compared PRESTO to TRISS using ROC analyses.<br />Results: Among 651,030 patients, there were 64% males. Median age was 7. In-hospital mortality-rate was 1.2%. Mean TRISS predicted mortality was 0.04% (range 0%-43%). Independent predictors included in PRESTO (p<0.01) were age, blood pressure, neurologic status, need for supplemental oxygen, pulse, and oxygen saturation. The sensitivity and specificity of PRESTO were 95.7% and 94.0%. The resulting model had an AUC of 0.98 compared to 0.89 for TRISS.<br />Conclusion: PRESTO satisfies the requirements of low-resource settings and is inherently adapted to children, allowing for benchmarking and eventual quality improvement initiatives. Further research is necessary for in-situ validation using prospectively collected LMIC data.<br />Level of Evidence: Level III - Case-Control (Prognostic) Study.<br /> (Copyright © 2017 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1531-5037
Database :
MEDLINE
Journal :
Journal of pediatric surgery
Publication Type :
Academic Journal
Accession number :
29092771
Full Text :
https://doi.org/10.1016/j.jpedsurg.2017.10.039