title: Predictors of mortality in pediatric trauma: experiences of a level 1 trauma center and an assessment of the International Classification Injury Severity Score (ICISS).
abstract: OBJECTIVE
  Injury severity scoring tools allow systematic comparison of outcomes in trauma research and quality improvement by indexing an expected mortality risk for certain injuries. This study investigated the predictive value of the empirically derived ICD9-derived Injury Severity Score (ICISS) compared to expert consensus-derived scoring systems for trauma mortality in a pediatric population.
  
  
  METHODS
  1935 consecutive trauma patients aged <18 years from 1/2000 to 12/2012 were reviewed. Mechanism of injury (MOI), Injury Severity Score (ISS), Revised Trauma Score (RTS), Trauma Score ISS (TRISS), and ICISS were compared using univariate and multivariate logistic regression analysis and receiver operator characteristic analysis.
  
  
  RESULTS
  The population was a median age of 11 ± 6 year, 70 % male, and 76 % blunt injury. Median ISS 13 ± 12 and overall mortality 3.5 %. Independent predictors of mortality were initial hematocrit [odds ratio (OR) 0.83 (0.73-0.95)], HCO3 [OR 0.82 (0.67-0.98)], Glasgow Coma Scale score [OR 0.75 (0.62-0.90)], and ISS [OR 1.10 (1.04-1.15)]. TRISS was superior to ICISS in predicting survival [area under receiver operator curve: 0.992 (0.982-1.000) vs 0.888 (0.838-0.938)].
  
  
  CONCLUSIONS
  ICISS was inferior to existing injury scoring tools at predicting mortality in pediatric trauma patients.
authors.affiliation: Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Casey J
authors.initials: CJ
authors.lastname: Allen
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wagenaar
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA.
authors.forename: Davis B
authors.initials: DB
authors.lastname: Horkan
authors.affiliation: Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Baldor
authors.affiliation: Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Hannay
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Tashiro
authors.affiliation: Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Namias
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA. jsola@med.miami.edu.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Sola
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005431:Florida / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D012372:ROC Curve; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000145:classification* / Q000401:mortality*
keywords: Children; ICISS; Injury; Mortality; Pediatric Trauma; Survival; TRISS; Trauma outcomes