Validation of age-specific survival prediction in pediatric patients with blunt trauma using trauma and injury severity score methodology: a ten-year Nationwide observational study

Validation of age-specific survival prediction in pediatric patients with blunt trauma using trauma and injury severity score methodology: a ten-year Nationwide observational study

Trauma scoring system, Trauma and injury severity score, Survival probability, Children, Japan trauma data bank

Background: In-hospital mortality in trauma patients has decreased recently owing to improved trauma injury
prevention systems. However, no study has evaluated the validity of the Trauma and Injury Severity Score (TRISS) in
pediatric patients by a detailed classification of patients’ age and injury severity in Japan. This retrospective
nationwide study evaluated the validity of TRISS in predicting survival in Japanese pediatric patients with blunt
trauma by age and injury severity.
Methods: Data were obtained from the Japan Trauma Data Bank during 2009–2018. The outcomes were as follows:
(1) patients’ characteristics and mortality by age groups (neonates/infants aged 0 years, preschool children aged 1–
5 years, schoolchildren aged 6–11 years, and adolescents aged 12–18 years), (2) validity of survival probability (Ps)
assessed using the TRISS methodology by the four age groups and six Ps-interval groups (0.00–0.25, 0.26–0.50,
0.51–0.75, 0.76–0.90, 0.91–0.95, and 0.96–1.00), and (3) the observed/expected survivor ratio by age- and Ps-interval
groups. The validity of TRISS was evaluated by the predictive ability of the TRISS method using the receiver
operating characteristic (ROC) curves that present the sensitivity, specificity, positive predictive value, negative
predictive value, accuracy, area under the receiver operator characteristic curve (AUC) of TRISS.
Results: In all the age categories considered, the AUC for TRISS demonstrated high performance (0.935, 0.981,
0.979, and 0.977). The AUC for TRISS was 0.865, 0.585, 0.614, 0.585, 0.591, and 0.600 in Ps-interval groups (0.96–1.00),
(0.91–0.95), (0.76. − 0.90), (0.51–0.75), (0.26–0.50), and (0.00–0.25), respectively. In all the age categories considered,
the observed survivors among patients with Ps interval (0.00–0.25) were 1.5 times or more than the expected
survivors calculated using the TRISS method.

Chiaki Toida , Takashi Muguruma, Masayasu Gakumazawa, Mafumi Shinohara, Takeru Abe, Ichiro Takeuchi and Naoto Morimura

BMC Emergency Medicine

(2020) 20:91

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