Prediction of mortality in pediatric trauma patients: new injury severity score outperforms injury severity score in the severely injured.
BACKGROUND
The Injury Severity Score (ISS) is a widely accepted method of measuring severity of traumatic injury. A modification has been proposed--the New Injury Severity Score (NISS). This has been shown to predict mortality better in adult trauma patients, but it had no predictive benefit in pediatric patients. The aim of this study was to determine whether the NISS outperforms the ISS in a large pediatric trauma population.


METHODS
Admissions in the National Pediatric Trauma Registry between April 1996 and September 1999 were included. The ISS and NISS were calculated for each patient. The study endpoints were mortality at hospital discharge, functional outcome in three domains (expression, locomotion, and feeding), and discharge disposition for the survivors. Predictive ability of each score was assessed by area under the receiver operating characteristic curve.


RESULTS
The NISS and ISS performed equally well at predicting mortality in patients with lower injury severity (ISS < 25), but the NISS was significantly better at predicting mortality in the more severely injured patients. Both scores performed equally well at predicting expression and feeding ability. The NISS was superior to the ISS in predicting locomotion ability at discharge. Thirty-seven percent of patients had an NISS that was higher than their ISS. These patients had a significantly higher mortality and suffered worse functional outcomes.


CONCLUSIONS
The NISS performs as well as the ISS in pediatric patients with lower injury severity and outperforms the ISS in those with higher injury severity.
Sullivan
Thomas
T
Department of Surgery, New York Medical College, Valhalla, 10595, USA.
Haider
Adil
A
DiRusso
Stephen M
SM
Nealon
Peter
P
Shaukat
Aasma
A
Slim
Michel
M
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016002:Discriminant Analysis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012372:ROC Curve; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000145:classification* / Q000150:complications / Q000401:mortality* / Q000628:therapy; D014950:Wounds, Penetrating / Q000145:classification* / Q000150:complications / Q000401:mortality* / Q000628:therapy