The value of prognostic markers for pediatric trauma patients

doi:10.5847/wjem.j.1920-8642.2023.100

Abstract

Abstract:

BACKGROUND: Despite the rapid development of pediatric intensive care medicine, there are still limited data in the literature regarding the follow-up of pediatric trauma patients in pediatric intensive care units (PICUs). In this study, we aim to evaluate our experience with children admitted and followed up with the diagnosis of trauma at our PICU.

METHODS: We evaluated the retrospective data of 77 pediatric trauma patients who were admitted to the PICU at Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital from August 2020 to December 2022. The demographic data, clinical parameters and laboratory results were recorded. The primary outcome was the mortality in PICU. The performances of markers in predicting mortality were evaluated with receiver operating characteristic (ROC) curves.

RESULTS: The median age of the patients was 70 (33-157) months, and the median duration of hospitalization in the PICU was 6 (2-11) d. Of the 77 patients, 9 died due to trauma (11,1%). Among the clinical parameters, Pediatric Risk of Mortality III (PRISM III) Score, inotrope requirement, extracorporeal treatment requirement, and mechanical ventilator requirement were significantly higher in non-survivors than in survivors. Among the laboratory parameters, procalcitonin (PCT), lactate/albumin ratio (LAR), neutrophil/lymphocyte ratio (NLR), and transfusion requirement were significantly higher in non-survivors than in survivors.

CONCLUSION: In pediatric trauma patients, baseline PCT, LAR, and NLR values can be used to identify patients at risk for mortality.

Key words: Critical care, Pediatric, Lactate, Procalcitonin, Trauma

Cansu Durak, Ebru Guney Sahin, Yasar Yusuf Can, Alican Sarisaltik, Kubra Boydag Guvenc. The value of prognostic markers for pediatric trauma patients[J]. World Journal of Emergency Medicine, 2023, 14(6): 448-453.

Figures/Tables 6

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Variables	Non-survivors (n=9)	Survivors (n=68)	P-value
PRISM III score	21 (21-28)	5 (2-8)	<0.001
Pediatric trauma score	-1 (-2-1)	9 (4-10)	<0.001
Length of hospital stay, d	2 (2-12)	6 (2.5-11)	0.169
Trauma regions			0.039
One system (head/thorax/abdominal/orthopedic)	2 (22.2%)	41 (60.3%)
Multisystem trauma (two or more)	7 (77.7%)	27 (39.7%)
Acute renal failure	3 (33.3%)	1 (1.5%)	0.004
Inotropic agent requirement	9 (100.0%)	9 (13.2%)	<0.001
TPE requirement	2 (22.2%)	1 (1.5%)	0.035
CRRT requirement	3 (33.3%)	0 (0.0)	0.001
Mechanical ventilation requirement	9 (100%)	28 (41.2%)	0.001
Duration of invasive mechanical ventilation, d	2 (2-12)	3.5 (3-11)	0.213
Hyponatremia	1 (11.1%)	14 (20.6%)	0.680
RDW	14.6 (12.5-17.1)	13.2 (12.6-14.0)	0.130
Platelets, ×10³	146 (107-188)	250 (210-298)	0.002
Prothrombin time, s	48.7 (34-64.85)	17 (15.9-19.57)	<0.001
Activated partial thromboplastin time, s	77.6 (44.8-107.75)	29.95 (26.87-32.27)	<0.001
Lactate/albumin ratio	3.05 (1.79-4.64)	0.39 (0.25-0.56)	<0.001
Procalcitonin, ng/mL	5.80 (1.20-6.60)	0.63 (0.12-3.20)	0.014
C-reactive protein, mg/dL	4.01 (0.95-15.97)	2.27 (1.50-17.78)	0.824
Neutrophil/lymphocyte ratio	6.94 (2.80-12.22)	2.80 (1.35-3.75)	0.021
PRBC transfusion	8 (88.8%)	29 (42.6%)	0.012
PS transfusion	4 (44.4%)	2 (2.9%)	0.001

Markers	Cut-off value	Sensitivity (%)	Specificity (%)	AUC (95.0% CI)	P-value
PRISM III score	18.500	100.0	95.6	0.978 (0.949-1.000)	<0.001
Procalcitonin	1.105 ng/mL	77.8	63.1	0.753 (0.606-0.900)	0.014
LAR	0.535	100.0	72.1	0.958 (0.898-1.000)	<0.001
NLR	3.120	73.5	66.7	0.738 (0.562-0.913)	0.021

Factors	Procalcitonin<1.105 (n=42)	Procalcitonin ≥1.105 (n=32)	P-value
CRRT requirement, n (%)			0.999
Yes	2 (4.8)	1 (3.1)
No	40 (95.2)	31 (96.9)
Inotropic agent requirement, n (%)			0.021
Yes	6 (14.3)	12 (37.5)
No	36 (85.7)	20 (62.5)
TPE requirement, n (%)			0.999
Yes	2 (4.8)	1 (3.1)
No	40 (95.2)	31 (96.9)
Mechanical ventilation requirement, n (%)			0.022
Yes	15 (35.7)	20 (62.5)
No	27 (64.3)	12 (37.5)
Length of hospital stay, d, median (IQR)	4 (2-10)	7 (3-13.5)	0.091

Factors	LAR <0.535 (n=49)	LAR ≥0.535 (n=28)	P-value
CRRT requirement, n (%)			0.045
Yes	0 (0.0)	3 (10.7)
No	49 (100.0)	25 (89.3)
Inotropic agent requirement, n (%)			<0.001
Yes	2 (4.1)	16 (57.1)
No	47 (95.9)	12 (42.9)
TPE requirement, n (%)			0.045
Yes	0 (0.0)	3 (10.7)
No	49 (100.0)	25 (89.3)
Mechanical ventilation requirement, n (%)			<0.001
Yes	16 (32.7)	21 (75.0)
No	33 (67.3)	7 (25.0)
Length of hospital stay, d, median (IQR)	6 (2-10)	6 (2-16.5)	0.488

Factors	NLR ≥3.120 (n=24)	NLR <3.120 (n=53)	P-value
CRRT requirement, n (%)			0.028
Yes	3 (12.5)	0 (0.0)
No	21 (87.5)	53 (100.0)
Inotropic agent requirement, n (%)			0.165
Yes	8 (33.3)	10 (18.9)
No	16 (66.7)	43 (81.1)
TPE requirement, n (%)			0.028
Yes	3 (12.5)	0 (0.0)
No	21 (87.5)	53 (100.0)
Mechanical ventilation requirement, n (%)			0.538
Yes	12 (50.0)	25 (47.2)
No	12 (50.0)	28 (52.8)
Length of hospital stay, d, median (IQR)	6 (2-12)	4 (2-9.5)	0.151