Implementation of a Level 1 Neuro Trauma Activation at a Tertiary Pediatric Trauma Center

Patterson, Kelli N.; Nordin, Andrew B.; Beyene, Addisu Shunu; Onwuka, Amanda; Bergus, Katherine; Horvath, Kyle Z; Sribnick, Eric A.; Thakkar, Rajan K.

doi:10.1016/j.jss.2022.02.013

Journal of Surgical Research

2022

DOI: 10.1016/j.jss.2022.02.013

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Implementation of a Level 1 Neuro Trauma Activation at a Tertiary Pediatric Trauma Center

Kelli N. Patterson

Andrew B. Nordin

Addisu Shunu Beyene

et al.

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2023

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“…Implementation of a "Level 1 neurotrauma alert" reduced the time to anesthesia induction, surgical incision, disposition from the emergency department to the pediatric intensive care unit, and ICP monitor placement at a stand-alone American College of Surgeons-verified Level 1 pediatric trauma program. 7 Activation of this alert increased the accessibility of plasma products and allowed time for the operating room and intensive care unit staff to allocate resources necessary for TBI management. Criteria used to trigger this activation were developed using domain knowledge instead of a data-driven approach.…”

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Development and validation of a Bayesian network predicting neurosurgical intervention after injury in children and adolescents

Sullivan

Sippel

Matison

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND:Timely surgical decompression improves functional outcomes and survival among children with traumatic brain injury and increased intracranial pressure. Previous scoring systems for identifying the need for surgical decompression after traumatic brain injury in children and adults have had several barriers to use. These barriers include the inability to generate a score with missing data, a requirement for radiographic imaging that may not be immediately available, and limited accuracy. To address these limitations, we developed a Bayesian network to predict the probability of neurosurgical intervention among injured children and adolescents (aged 1-18 years) using physical examination findings and injury characteristics observable at hospital arrival. METHODS:We obtained patient, injury, transportation, resuscitation, and procedure characteristics from the 2017 to 2019 Trauma Quality Improvement Project database. We trained and validated a Bayesian network to predict the probability of a neurosurgical intervention, defined as undergoing a craniotomy, craniectomy, or intracranial pressure monitor placement. We evaluated model performance using the area under the receiver operating characteristic and calibration curves. We evaluated the percentage of contribution of each input for predicting neurosurgical intervention using relative mutual information (RMI). RESULTS:The final model included four predictor variables, including the Glasgow Coma Scale score (RMI, 31.9%), pupillary response (RMI, 11.6%), mechanism of injury (RMI, 5.8%), and presence of prehospital cardiopulmonary resuscitation (RMI, 0.8%).The model achieved an area under the receiver operating characteristic curve of 0.90 (95% confidence interval [CI], 0.89-0.91) and had a calibration slope of 0.77 (95% CI, 0.29-1.26) with a y intercept of 0.05 (95% CI, −0.14 to 0.25). CONCLUSION:We developed a Bayesian network that predicts neurosurgical intervention for all injured children using four factors immediately available on arrival. Compared with a binary threshold model, this probabilistic model may allow clinicians to stratify management strategies based on risk.

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mentioning

confidence: 99%

Development and validation of a Bayesian network predicting neurosurgical intervention after injury in children and adolescents

Sullivan

Sippel

Matison

et al. 2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

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Implementation of a Level 1 Neuro Trauma Activation at a Tertiary Pediatric Trauma Center

Cited by 1 publication

References 21 publications

Development and validation of a Bayesian network predicting neurosurgical intervention after injury in children and adolescents

Development and validation of a Bayesian network predicting neurosurgical intervention after injury in children and adolescents

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