Evaluating the prognosis of multiple, severely traumatized children in the intensive care unit.
OBJECTIVE
To assess the Pediatric Risk of Mortality (PRISM) score and to identify other prognosis factors in severe, multiple trauma in children.


METHODS
Retrospective study over a 9-year period.


METHODS
A Pediatric Intensive Care Unit (PICU) in a University Hospital.


METHODS
One hundred and thirty-three traumatized children, 8.6 years (8 months-16 years), were reviewed.


METHODS
None.


RESULTS
Pediatric Trauma Score (PTS), Injury Severity Score (ISS), New ISS (NISS), Glasgow Coma Scale (GCS) score, and PRISM were calculated. The areas under the Receiver Operating Characteristic (ROC Az) curves, were compared. Univariate and multivariate analyses were performed. The mortality rate was 25.6%. PRISM performed well for discrimination between survivors and non-survivors. Az PRISM 0.9387 (0.029) was not different from Az GCS score 0.9451 (0.027) (P=0.568), but was significantly different from Az ISS 0.756 (0.052) (P<0.001), Az NISS 0.7606 (0.051) (P<0.001), and Az PTS 0.8244 (0.047) (P=0.016). Death was significantly associated with head trauma (P=0.014), PRISM >35, PTS <5, GCS <7, and ISS or NISS >32 (P<0.00001). PRISM >35 (P=0.001) and GCS <7 (P=0.003) were independent risk factors of death.


CONCLUSIONS
PRISM is a reliable tool for evaluating the prognosis of multiple, severely traumatized children. Its relative simplicity and the fact that it is extremely widespread as a general prognosis score in PICUs represent other arguments for its use. Due to the leading influence of head trauma on mortality, GCS, a score even simpler than PRISM, showed identical accuracy regarding survival prediction.
Cantais
E
E
Department of Pediatric Anesthesiology and Intensive Care, La Timone Children's Hospital, Bd Jean Moulin, 13385 Marseille, France.
Paut
O
O
Giorgi
R
R
Viard
L
L
Camboulives
J
J
D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D016002:Discriminant Analysis; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D009104:Multiple Trauma / Q000145:classification* / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015599:Trauma Severity Indices