PAEDIATRIC OUT-OF-HOSPITAL TRAUMATIC CARDIAC ARREST: A REVIEW OF THE PS14 SURVIVAL PREDICTION MODEL

Objectives & Background Trauma is a leading cause of death in children. Paediatric out-of-hospital traumatic cardiac arrest (POOHTCA) is a subsection of this. The Ps14 survival prediction model is used to predict survival in trauma patients on the Trauma Audit and Research Network (TARN) database. TARN collects and audits data from all trauma receiving hospitals in the UK and many others internationally. It has been hypothesised that there is a difference between the Ps14 survival prediction for POOHTCA and actual survival for POOHTCA patients on the TARN database. Methods Data from the TARN database between 1989–2015 was analysed. A comparison between the Ps14 and actual survival was made. Univariate and logistic regression analyses were conducted on the data using SPSS. A new model to predict survival after POOHTCA was constructed and a comparison between the Ps14 and the new model was made. Results There was a significant difference between the Ps14 prediction model and actual survival. For Known outcomes, predicted survival was 44.9% (95% CI 40.2–49.5%) compared with actual survival of 5.0% (95% CI 3.0%–7.0%). On univariate analysis, age, drowning, year of presentation and time from scene to Emergency Department were found to be significantly different between survivors and non-survivors. Further logistic regression showed only year of presentation and those who received care in the most recent time cohort, remained significant with the remaining variables losing significance. Three models of varying care and patient factors were constructed. The new models were not significantly different to the Ps14 model, C-statistic: 0.709 (95% CI 0.614–0804), 0.709 (0.614–0804) 0.798 (0.672–0.920) and 0.715 (0.603–0.827) for models 1,2,3 and Ps14 respectively. Conclusion The current Ps14 model is not a good predictor of survival for POOHTCA patients. This is most likely due to the small number of POOHTCA patients that survive to discharge. Although the model could be improved with a larger data set, it has been suggested that a traumatic arrest variable could be inserted into the Ps14 model which would reduce predicted survival to between 3% and 7% for this patient population. This would be much closer to actual survival rates and could improve the audit of paediatric trauma care.