Development and validation of a new pediatric resuscitation and trauma outcome (PRESTO) model using the U.S. National Trauma Data Bank

St-Louis, Etienne; Bracco, David; Hanley, James A.; Razek, Tarek; Baird, Robert

doi:10.1016/j.jpedsurg.2017.10.039

Cited by 11 publications

(29 citation statements)

References 21 publications

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“…Our study reports an overall PICU mortality of 1,7% for major paediatric trauma. This is within the range of previous studies that demonstrate mortality rates that vary from 1,2% to 12,8% in the USA, Canada, Australia, Japan and Europe [13,21,22,23,24,25,26]. However, the inclusion criteria vary signi cantly between these studies, some including severe non-traumatic injuries such as poisoning and drowning, or patients not admitted to PICU, and therefore the results are not suitable for direct comparison.…”

Section: Mortality and In-hospital Outcomessupporting

confidence: 64%

Epidemiology of Major Paediatric Trauma in a European Country – Trends of a Decade

Castelão

Lopes

Vieira

2023

Preprint

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Objectives This study describes the epidemiology of severe injuries related to trauma in children and assesses potential preventive areas. Methods Single-centre retrospective study of paediatric trauma patients admitted to a Paediatric Intensive Care Unit (PICU) in a tertiary university hospital in Europe, from 2009 to 2019. Results Total 358 patients included (age 11 ± 4,9 years; 67% male); 75% were involved in road traffic accidents: 30% motor vehicle collision, 25% pedestrian, 10% motorcycle and bicycle each. Falls from height injured 19% of children, 4% during sports activities. Main injuries were to head/neck (73%) and extremities (42%). The incidence of major trauma was highest in teenagers and did not show a decreasing trend during the study years. All fatalities (1,7%; n = 6) were related to head/neck injuries. Motor vehicle collisions resulted in higher need for blood transfusion (9 vs 2 mL/kg, p = 0,006) and the highest ICU-mortality (83%; n = 5). Children in motorcycle accidents had longer ICU length-of-stay (6,4 vs 4,2 days, p = 0,036). Pedestrians had 25% higher risk of head/neck injuries (RR 1,25; 1,07 − 1,46; p = 0,004), and higher incidence of severe brain injury (46% vs 34%, p = 0,042). Most children in motor-vehicle/bicycle accidents were not using restraints/protective devices (45%) or were using them inappropriately (13%). Conclusions Over the last decade, the absolute numbers of paediatric major trauma did not decrease. Road traffic accidents remain the leading cause of injury and death. Teenagers are at highest risk for severe trauma. Appropriate use of child restraints and protective equipment remain key for prevention.

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Section: Mortality and In-hospital Outcomessupporting

confidence: 64%

Epidemiology of Major Paediatric Trauma in a European Country – Trends of a Decade

Castelão

Lopes

Vieira

2023

Preprint

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“…In-hospital mortality of pediatric trauma patients was reported to vary from 0.3% to 8.5% in the USA, Canada, Afghanistan, Iraq, and Europe 32–38 . In this report, the overall in-hospital mortality was 3.9% between 2004 and 2015 and mortality decreased to 2.5% for the 2011–2015 period similar or a little higher than that of other developed countries 32,33,35–38 . As age decreased, mortality has been previously reported to increase 39 , in agreement with this study.…”

Section: Discussionmentioning

confidence: 47%

Epidemiology, Patterns of treatment, and Mortality of Pediatric Trauma Patients in Japan

Aoki

Abe

Saitoh

et al. 2019

Sci Rep

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Limited information exists regarding the epidemiology, patterns of treatment, and mortality of pediatric trauma patients in Japan. To evaluate the characteristics and mortality of pediatric trauma patients in Japan, especially in traffic accidents. This was a retrospective cohort study between 2004 and 2015 from a nationwide trauma registry in Japan. Pediatric trauma patients divided into four age groups: <1 years; 1 ≤ 5 years; 6 ≤ 10 years; and 11 ≤ 15 years. Data on patients’ demographics, trauma mechanism and severity, treatments and in-hospital mortality were analyzed between the groups. There were 15,441 pediatric trauma patients during the study period. Among 15,441 pediatric patients, 779 belonged to the <1 year age group, 3,933 to the 1 ≤ 5 years age group, 5,545 to the 6 ≤ 10 age group, and 5,184 to the 11 ≤ 15 years age group. Male injuries (69%) were more frequent than female injuries. Head injuries (44%) were the most frequent and severe. Traffic accidents were the leading cause of trauma (44%). Overall in-hospital mortality was 3.9% and emergency department mortality was 1.4%. In-hospital mortality was 5.3%, 4.7%, 3.0% and 4.0% for the <1 year, 1 ≤ 5 years, 6 ≤ 10 years, and 11 ≤ 15 years age groups respectively. A total of 57% of all trauma deaths were before or upon arrival at hospital. Traffic accidents for the <1 year age group was the highest category of mortality (15%). The overall in-hospital mortality of Japanese pediatric trauma patients was 3.9% based on the nationwide trauma registry of Japan. The main cause of severe trauma was traffic accidents, especially in patients <1 year of age whose mortality was 15%.

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“…The variables included in the logistic regression model were selected according to the original PRESTO model, 5 namely: age, noted hypotension (SBP), HR, O 2 saturation, need for SO (airway support) and neurologic status (AVPU). We also tested if delays to presentation to definitive care at KCMC significantly impacted our model performance.…”

Section: Methodsmentioning

confidence: 99%

“… 4 Most trauma predictor scores developed and used in high-income countries (HICs) require variables not commonly available in LMIC settings. 5 In order to address the need for LMIC-specific paediatric trauma outcome indicators, St-Louis et al developed the Pediatric Resuscitation and Trauma Outcome (PRESTO) model for predicting short-term mortality using initial patient assessment variables appropriate for and available in low-resource settings. 5 The PRESTO model has been shown to outperform other trauma scores in children less than 5 years of age.…”

Section: Introductionmentioning

confidence: 99%

“…It was initially validated using the United States National Trauma Data Bank and has subsequently been validated in a middle-income setting (South Africa) and an LMIC setting (Rwanda). 5–7 In its application and validation in Rwanda, it was shown to be similarly effective in predicting child mortality as the Revised Trauma Score and Kampala Trauma Score, and to outperform the Kampala Trauma Score in children less than 5 years of age. 6 …”

Section: Introductionmentioning

confidence: 99%

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Validation of the Pediatric Resuscitation and Trauma Outcome (PRESTO) model in injury patients in Tanzania

et al. 2023

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IntroductionSub-Saharan Africa has the highest rate of unintentional paediatric injury deaths. The Pediatric Resuscitation and Trauma Outcome (PRESTO) model predicts mortality using patient variables available in low-resource settings: age, systolic blood pressure (SBP), heart rate (HR), oxygen saturation, need for supplemental oxygen (SO) and neurologic status (Alert Verbal Painful Unresponsive (AVPU)). We sought to validate and assess the prognostic performance of PRESTO for paediatric injury patients at a tertiary referral hospital in Northern Tanzania.MethodsThis is a cross-sectional study from a prospective trauma registry from November 2020 to April 2022. We performed exploratory analysis of sociodemographic variables and developed a logistic regression model to predict mortality using R (V.4.1). The logistic regression model was evaluated using area under the receiver operating curve (AUC).Results499 patients were enrolled with a median age of 7 years (IQR 3.41–11.18). 65% were boys, and in-hospital mortality was 7.1%. Most were classified as alert on AVPU Scale (n=326, 86%) and had normal SBP (n=351, 98%). Median HR was 107 (IQR 88.5–124). The logistic regression model based on the original PRESTO model revealed that AVPU, HR and SO were statistically significant to predict in-hospital mortality. The model fit to our population revealed AUC=0.81, sensitivity=0.71 and specificity=0.79.ConclusionThis is the first validation of a model to predict mortality for paediatric injury patients in Tanzania. Despite the low number of participants, our results show good predictive potential. Further research with a larger injury population should be done to improve the model for our population, such as through calibration.

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Development and validation of a new pediatric resuscitation and trauma outcome (PRESTO) model using the U.S. National Trauma Data Bank

Cited by 11 publications

References 21 publications

Epidemiology of Major Paediatric Trauma in a European Country – Trends of a Decade

Epidemiology of Major Paediatric Trauma in a European Country – Trends of a Decade

Epidemiology, Patterns of treatment, and Mortality of Pediatric Trauma Patients in Japan

Validation of the Pediatric Resuscitation and Trauma Outcome (PRESTO) model in injury patients in Tanzania

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