Open AccessDevelopment of a Mortality Prediction Tool in Pediatric Severe Traumatic Brain Injury
Author(s) -
Kawmadi Abeytunge,
Michael R. Miller,
Shona Cameron,
Tanya Charyk Stewart,
Ibrahim M. Alharfi,
Douglas D. Fraser,
Janice A. Tijssen
Publication year - 2021
Publication title -
neurotrauma reports
Language(s) - English
Resource type - Journals
ISSN - 2689-288X
DOI - 10.1089/neur.2020.0039
Subject(s) - glasgow coma scale , medicine , sedation , receiver operating characteristic , pediatric intensive care unit , area under the curve , traumatic brain injury , head injury , emergency medicine , intensive care unit , anesthesia , pediatrics , surgery , psychiatry
Severe traumatic brain injury (sTBI) is a leading cause of pediatric death, yet outcomes remain difficult to predict. The goal of this study was to develop a predictive mortality tool in pediatric sTBI. We retrospectively analyzed 196 patients with sTBI (pre-sedation Glasgow Coma Scale [GCS] score < 8 and head Maximum Abbreviated Injury Scale (MAIS) score > 4) admitted to a pediatric intensive care unit (PICU). Overall, 56 patients with sTBI (29%) died during PICU stay. Of the survivors, 88 (63%) were discharged home, and 52 (37%) went to an acute care or rehabilitation facility. Receiver operating characteristic (ROC) curve analyses of admission variables showed that pre-sedation GCS score, Rotterdam computed tomography (CT) score, and partial thromboplastin time (PTT) were fair predictors of PICU mortality (area under the curve [AUC] = 0.79, 0.76, and 0.75, respectively; p < 0.001). Cutoff values best associated with PICU mortality were pre-sedation GCS score < 5 (sensitivity = 0.91, specificity = 0.54), Rotterdam CT score > 3 (sensitivity = 0.84, specificity = 0.53), and PTT > 34.5 sec (sensitivity = 0.69 specificity = 0.67). Combining pre-sedation GCS score, Rotterdam CT score, and PTT in ROC curve analysis yielded an excellent predictor of PICU mortality (AUC = 0.91). In summary, pre-sedation GCS score ( < 5), Rotterdam CT score ( > 3), and PTT ( > 34.5 sec) obtained on hospital admission were fair predictors of PICU mortality, ranked highest to lowest. Combining these three admission variables resulted in an excellent pediatric sTBI mortality prediction tool for further prospective validation.