Abstracts Category : Other

Development and validation of the pediatric resuscitation and trauma outcome (presto) score - a new pediatric trauma score adapted for use in low-resource settings

by Etienne St-Louis

Introduction Trauma is a leading cause of pediatric mortality and morbidity in Low- and Middle-Income Countries (LMICs). Trauma registries contribute to better outcomes by including a score that allows benchmarking of performance across different sites or within a particular site over time. A variety of trauma scores exists, many of which are quite sophisticated. However, trauma registries used in high-income countries (HICs) are prohibitively expensive in LMICs. Two limitations need to be overcome to successfully implement effective trauma registries in LMICs the cost of registry operation must be context appropriate, and the variables within the registry must be relevant to the patient population and setting they are intended for. We sought to develop a new Pediatric Resuscitation and Trauma Outcome (PRESTO) model adapted to pediatric patients in LMICs in order to facilitate trauma outcome benchmarking and enable quality improvement initiatives for this at-risk population. Methods Despite a proliferation of trauma registries in LMICs over the last decade, the amount of LMIC pediatric trauma data remains insufficient to allow in situ development and validation of a novel pediatric trauma score. Therefore, data from the U.S. National Trauma Data Bank (NTDB) was used. A systematic review of the literature was performed to identify all trauma scores used in the pediatric population and perform qualitative analysis of their settings of use, components and limitations. We performed a modified Delphi analysis by summarizing the conclusions of the systematic review in survey format and submitting it to a group of experts. We measured the strength of their agreement and consensus with various statements. This provided useful insight into the limitations and characteristics of a trauma score designed for pediatric patients in LMICs. The best fitting predictive model generated from a stepwise logistic regression analysis of the NTDB data could be compared with the PRESTO model, which only included "low-tech" variables. The outcome of interest was in-hospital mortality. Patients were included if they were < 15 years old and were excluded if the outcome was not recorded. Results The systematic review showed that trauma scores developed specifically for LMICs lack validation in children, while trauma scores developed specifically for children usually require advanced diagnostic imaging or laboratory data that may not be consistently available in LMICs. Therefore, a gap exists in our ability to simply and reliably estimate injury severity in pediatric patients and predict their associated probability of mortality in LMICs. An ideal score should be easy to calculate using point-of care data that is readily available in LMICs, and can be easily adapted to the specific physiologic variations of different age groups. These conclusions were echoed by consensus generation through Delphi survey analysis among a group of 19 experts. In our analysis of NTDB data we found that the PRESTO model, which includes age category,Advisors/Committee Members: James Anthony Hanley (Internal/Supervisor), Tarek Razek (Internal/Cosupervisor2).