Quality of pediatric trauma care: development of an age-adjusted TRISS model and survival benchmarking in a major trauma center
BackgroundPediatric trauma is a major global health concern, accounting for a substantial proportion of deaths and disease burden from age 5 onwards. Effective triage and management are essential in pediatric trauma care, and prediction models such as the Trauma Injury Severity Score (TRISS) play a...
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Frontiers Media S.A.
2024-12-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2024.1481467/full |
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| author | Ana De los Ríos-Pérez Ana De los Ríos-Pérez Alberto Federico García Alberto Federico García Paula Gomez Paula Gomez Juan José Arias Juan José Arias Andrés Fandiño-Losada Andrés Fandiño-Losada |
| author_facet | Ana De los Ríos-Pérez Ana De los Ríos-Pérez Alberto Federico García Alberto Federico García Paula Gomez Paula Gomez Juan José Arias Juan José Arias Andrés Fandiño-Losada Andrés Fandiño-Losada |
| author_sort | Ana De los Ríos-Pérez |
| collection | DOAJ |
| description | BackgroundPediatric trauma is a major global health concern, accounting for a substantial proportion of deaths and disease burden from age 5 onwards. Effective triage and management are essential in pediatric trauma care, and prediction models such as the Trauma Injury Severity Score (TRISS) play a crucial role in estimating survival probability and guiding quality improvement. However, TRISS does not account for age-specific factors in pediatric populations, limiting its applicability to younger patients. This study aimed to modify TRISS to account for age for children (Peds-TRISS) and to evaluate its performance relative to the original TRISS. We also assessed survival outcomes to explore the model's potential utility across various clinical settings. These efforts align with quality improvement initiatives to reduce preventable mortality and supporting sustainable development goals.MethodsThis retrospective cohort study included patients under 18 years of age who were treated at a hospital in Colombia between 2011 and 2019. New coefficients for TRISS covariates were calculated using logistic regression, with age treated as a continuous variable. Model performance was evaluated based on discrimination (C statistic) and calibration, comparing Peds-TRISS with the original TRISS. Internal validation was conducted using bootstrap resampling. Survival outcomes were assessed using the M and Z statistics, which are commonly used for international trauma outcome comparisons.ResultsThe study included 1,013 pediatric patients with a median age of 12 years (IQR 5–15), of whom 73% were male. The leading causes of injury were traffic accidents (31.1%), falls (28.8%), and assaults (28.7%). The overall mortality rate was 5.7%. The Peds-TRISS model demonstrated good calibration (HL = 9.7, p = 0.3) and discrimination (C statistic = 0.98, 95% CI 0.97–0.99), with no statistically significant difference in the ROC curve comparison with the original TRISS. Internal validation demonstrated strong performance of Peds-TRISS. The M and Z statistics were 0.93 and 0, respectively, indicating no significant differences between expected and observed survival rates.ConclusionsMost fatalities occurred among adolescents and were due to intentional injuries. The Peds-TRISS model showed a partial improvement in performance compared to the original TRISS, with superior results in terms of calibration, although not in discrimination. These findings highlight the potential of model customization for specific populations. Prospective, multicenter studies are recommended to further validate the model's utility across diverse settings. |
| format | Article |
| id | doaj-art-4974afc4d18f4cd4945c81e7dc873ee7 |
| institution | DOAJ |
| issn | 2296-2360 |
| language | English |
| publishDate | 2024-12-01 |
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| spelling | doaj-art-4974afc4d18f4cd4945c81e7dc873ee72025-08-20T02:50:19ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602024-12-011210.3389/fped.2024.14814671481467Quality of pediatric trauma care: development of an age-adjusted TRISS model and survival benchmarking in a major trauma centerAna De los Ríos-Pérez0Ana De los Ríos-Pérez1Alberto Federico García2Alberto Federico García3Paula Gomez4Paula Gomez5Juan José Arias6Juan José Arias7Andrés Fandiño-Losada8Andrés Fandiño-Losada9Pediatric Emergency Medicine, Fundación Valle del Lili Teaching Hospital, Cali, ColombiaFaculty of Health Sciences, Universidad Icesi, Cali, ColombiaFaculty of Health Sciences, Universidad Icesi, Cali, ColombiaTrauma & Acute Surgery, Critical Care, Fundación Valle del Lili Teaching Hospital, Cali, ColombiaPediatric Emergency Medicine, Fundación Valle del Lili Teaching Hospital, Cali, ColombiaFaculty of Health Sciences, Universidad Icesi, Cali, ColombiaPediatric Emergency Medicine, Fundación Valle del Lili Teaching Hospital, Cali, ColombiaFaculty of Health Sciences, Universidad Icesi, Cali, ColombiaFaculty of Health, Universidad del Valle, Cali, ColombiaCisalva Institute, Faculty of Health, Universidad del Valle, Cali, ColombiaBackgroundPediatric trauma is a major global health concern, accounting for a substantial proportion of deaths and disease burden from age 5 onwards. Effective triage and management are essential in pediatric trauma care, and prediction models such as the Trauma Injury Severity Score (TRISS) play a crucial role in estimating survival probability and guiding quality improvement. However, TRISS does not account for age-specific factors in pediatric populations, limiting its applicability to younger patients. This study aimed to modify TRISS to account for age for children (Peds-TRISS) and to evaluate its performance relative to the original TRISS. We also assessed survival outcomes to explore the model's potential utility across various clinical settings. These efforts align with quality improvement initiatives to reduce preventable mortality and supporting sustainable development goals.MethodsThis retrospective cohort study included patients under 18 years of age who were treated at a hospital in Colombia between 2011 and 2019. New coefficients for TRISS covariates were calculated using logistic regression, with age treated as a continuous variable. Model performance was evaluated based on discrimination (C statistic) and calibration, comparing Peds-TRISS with the original TRISS. Internal validation was conducted using bootstrap resampling. Survival outcomes were assessed using the M and Z statistics, which are commonly used for international trauma outcome comparisons.ResultsThe study included 1,013 pediatric patients with a median age of 12 years (IQR 5–15), of whom 73% were male. The leading causes of injury were traffic accidents (31.1%), falls (28.8%), and assaults (28.7%). The overall mortality rate was 5.7%. The Peds-TRISS model demonstrated good calibration (HL = 9.7, p = 0.3) and discrimination (C statistic = 0.98, 95% CI 0.97–0.99), with no statistically significant difference in the ROC curve comparison with the original TRISS. Internal validation demonstrated strong performance of Peds-TRISS. The M and Z statistics were 0.93 and 0, respectively, indicating no significant differences between expected and observed survival rates.ConclusionsMost fatalities occurred among adolescents and were due to intentional injuries. The Peds-TRISS model showed a partial improvement in performance compared to the original TRISS, with superior results in terms of calibration, although not in discrimination. These findings highlight the potential of model customization for specific populations. Prospective, multicenter studies are recommended to further validate the model's utility across diverse settings.https://www.frontiersin.org/articles/10.3389/fped.2024.1481467/fullinjuriespediatric traumatrauma severity indicestrauma scoreTRISStrauma injury severity score |
| spellingShingle | Ana De los Ríos-Pérez Ana De los Ríos-Pérez Alberto Federico García Alberto Federico García Paula Gomez Paula Gomez Juan José Arias Juan José Arias Andrés Fandiño-Losada Andrés Fandiño-Losada Quality of pediatric trauma care: development of an age-adjusted TRISS model and survival benchmarking in a major trauma center Frontiers in Pediatrics injuries pediatric trauma trauma severity indices trauma score TRISS trauma injury severity score |
| title | Quality of pediatric trauma care: development of an age-adjusted TRISS model and survival benchmarking in a major trauma center |
| title_full | Quality of pediatric trauma care: development of an age-adjusted TRISS model and survival benchmarking in a major trauma center |
| title_fullStr | Quality of pediatric trauma care: development of an age-adjusted TRISS model and survival benchmarking in a major trauma center |
| title_full_unstemmed | Quality of pediatric trauma care: development of an age-adjusted TRISS model and survival benchmarking in a major trauma center |
| title_short | Quality of pediatric trauma care: development of an age-adjusted TRISS model and survival benchmarking in a major trauma center |
| title_sort | quality of pediatric trauma care development of an age adjusted triss model and survival benchmarking in a major trauma center |
| topic | injuries pediatric trauma trauma severity indices trauma score TRISS trauma injury severity score |
| url | https://www.frontiersin.org/articles/10.3389/fped.2024.1481467/full |
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