TY  - JOUR
PY  - 2020//
TI  - Comparison of the Pediatric Resuscitation and Trauma Outcome (PRESTO) model and Pediatric Trauma Scoring Systems in a middle-income country
JO  - World journal of surgery
A1  - Traynor, Michael D.
A1  - St Louis, Etienne
A1  - Hernandez, Matthew C.
A1  - Alsayed, Ahmed S.
A1  - Klinkner, Denise B.
A1  - Baird, Robert
A1  - Poenaru, Dan
A1  - Kong, Victor Y.
A1  - Moir, Christopher R.
A1  - Zielinski, Martin D.
A1  - Laing, Grant L.
A1  - Bruce, John L.
A1  - Clarke, Damian L.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - BACKGROUND: The pediatric resuscitation and trauma outcome (PRESTO) model was developed to aid comparisons of risk-adjusted mortality after injury in low- and middle-income countries (LMICs). We sought to validate PRESTO using data from a middle-income country (MIC) trauma registry and compare its performance to the Pediatric Trauma Score (PTS), Revised Trauma Score, and pediatric age-adjusted shock index (SIPA). <br><br>METHODS: We included children (age < 15 years) admitted to a single trauma center in South Africa from December 2012 to January 2019. We excluded patients missing variables necessary for the PRESTO model-age, systolic blood pressure, pulse, oxygen saturation, neurologic status, and airway support. Trauma scores were assigned retrospectively. PRESTO's previously high-income country (HIC)-validated optimal threshold was compared to MIC-validated threshold using area under the receiver operating characteristic curves (AUROC). Prediction of in-hospital death using trauma scoring systems was compared using ROC analysis. <br><br>RESULTS: Of 1160 injured children, 988 (85%) had complete data for calculation of PRESTO. Median age was 7 (IQR: 4, 11), and 67% were male. Mortality was 2% (n = 23). Mean predicted mortality was 0.5% (range 0-25.7%, AUROC 0.93). Using the HIC-validated threshold, PRESTO had a sensitivity of 26.1% and a specificity of 99.7%. The MIC threshold showed a sensitivity of 82.6% and specificity of 89.4%. The MIC threshold yielded superior discrimination (AUROC 0.86 [CI 0.78, 0.94]) compared to the previously established HIC threshold (0.63 [CI 0.54, 0.72], p < 0.0001). PRESTO showed superior prediction of in-hospital death compared to PTS and SIPA (all p < 0.01). <br><br>CONCLUSION: PRESTO can be applied in MIC settings and discriminates between children at risk for in-hospital death following trauma. Further research should clarify optimal decision thresholds for quality improvement and benchmarking in LMIC settings.<p />  <p>Language: en</p>
LA  - en
SN  - 0364-2313
UR  - http://dx.doi.org/10.1007/s00268-020-05512-3
ID  - ref1
ER  -