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Open Access Highly Accessed Research article

Risk prediction score for death of traumatised and injured children

Sakda Arj-ong Vallipakorn14*, Adisak Plitapolkarnpim24, Paibul Suriyawongpaisal3, Pimpa Techakamolsuk5, Gary A Smith6 and Ammarin Thakkinstian1

Author Affiliations

1 Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Road, Rajathevi, Bangkok 10400, Thailand

2 Pediatric Ambulatory Units, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand

3 Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand

4 Child Safety Promotion and Injury Prevention Research Center (CSIP), and Safe Kids Thailand, Bangkok 10400, Thailand

5 Department of Disease Control, Ministry of Public Health, Nonthaburi, 11000 Thailand

6 Center for Injury Research and Policy, Nationwide Children’s Hospital, Columbus, OH 43205, USA

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BMC Pediatrics 2014, 14:60  doi:10.1186/1471-2431-14-60

Published: 28 February 2014

Abstract

Background

Injury prediction scores facilitate the development of clinical management protocols to decrease mortality. However, most of the previously developed scores are limited in scope and are non-specific for use in children. We aimed to develop and validate a risk prediction model of death for injured and Traumatised Thai children.

Methods

Our cross-sectional study included 43,516 injured children from 34 emergency services. A risk prediction model was derived using a logistic regression analysis that included 15 predictors. Model performance was assessed using the concordance statistic (C-statistic) and the observed per expected (O/E) ratio. Internal validation of the model was performed using a 200-repetition bootstrap analysis.

Results

Death occurred in 1.7% of the injured children (95% confidence interval [95% CI]: 1.57–1.82). Ten predictors (i.e., age, airway intervention, physical injury mechanism, three injured body regions, the Glasgow Coma Scale, and three vital signs) were significantly associated with death. The C-statistic and the O/E ratio were 0.938 (95% CI: 0.929–0.947) and 0.86 (95% CI: 0.70–1.02), respectively. The scoring scheme classified three risk stratifications with respective likelihood ratios of 1.26 (95% CI: 1.25–1.27), 2.45 (95% CI: 2.42–2.52), and 4.72 (95% CI: 4.57–4.88) for low, intermediate, and high risks of death. Internal validation showed good model performance (C-statistic = 0.938, 95% CI: 0.926–0.952) and a small calibration bias of 0.002 (95% CI: 0.0005–0.003).

Conclusions

We developed a simplified Thai pediatric injury death prediction score with satisfactory calibrated and discriminative performance in emergency room settings.

Keywords:
Logistic regression; Pediatric trauma and injury score; Prediction score; Injured child; Pediatric injury; Bootstrap