Evaluating the prognosis of multiple, severely traumatized children in the intensive care unit

Objective: To assess the Pediatric Risk of Mortality (PRISM) score and to identify other prognosis factors in severe, multiple trauma in children. Design: Retrospective study over a 9-year period. Setting: A Pediatric Intensive Care Unit (PICU) in a University Hospital. Patients and participants: One hundred and thirty-three traumatized children, 8.6 years (8 months-16 years), were reviewed. Interventions: None. Measurements and results: Pediatric Trauma Score (PTS), Injury Severity Score (ISS), New ISS (NISS), Glasgow Coma Scale (GCS) score, and PRISM were calculated. The areas under the Receiver Operating Characteristic (ROC Az) curves, were compared. Univariate and multivariate analyses were performed. The mortality rate was 25.6 %. PRISM performed well for discrimination between survivors and nonsurvivors. Az PRISM 0.9387 (0.029) was not different from Az GCS score 0.9451 (0. < EMPH TYPE = "6" > 027) (P = 0.568), but was significantly different from Az ISS 0.756 (0.052) (P < 0.001), Az NISS 0.7606 (0.051) (P < 0.001), and Az PTS 0.8244 (0.047) (P = 0.016). Death was significantly associated with head trauma (P = 0.014), PRISM > 35, PTS < 5, GCS < 7, and ISS or NISS > 32 (P < 0.00001). PRISM > 35 (P = 0.001) and GCS < 7 (P = 0.003) were independent risk factors of death. Conclusions: PRISM is a reliable tool for evaluating the prognosis of multiple, severely traumatized children. Its relative simplicity and the fact that it is extremely widespread as a general prognosis score in PlCUs represent other arguments for its use. Due to the leading influence of head trauma on mortality, GCS, a score even simpler than PRISM, showed identical accuracy regarding survival prediction.