Validation of the "CHIIDA" and application for PICU triage in children with complicated mild traumatic brain injury.

Autor: Neumayer KE; Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. Electronic address: katieneumayer@gmail.com., Sweney J; Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. Electronic address: jill.sweney@hsc.utah.edu., Fenton SJ; Division of Pediatric of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA. Electronic address: stephen.fenton@hsc.utah.edu., Keenan HT; Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. Electronic address: heather.keenan@hsc.utah.edu., Flaherty BF; Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. Electronic address: brian.flaherty@hsc.utah.edu.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2020 Jul; Vol. 55 (7), pp. 1255-1259. Date of Electronic Publication: 2019 Oct 24.
DOI: 10.1016/j.jpedsurg.2019.09.027
Abstrakt: Background: The Children's Intracranial Injury Decision Aid (CHIIDA) was developed to predict which patients with complicated mild traumatic brain injury (cmTBI; GCS ≥13 with depressed skull fracture or intracranial injury) would achieve the composite outcome of neurosurgical intervention, intubation >24 h, or death. The study also explored the CHIIDA as a triage tool to determine need for PICU care. The purpose of this study is to externally validate the CHIIDA and assess its effects on PICU triage.
Methods: Retrospective cohort study (January 2016 to December 2017) to validate the CHIIDA to predict the composite outcome and assess its effects as a PICU triage tool at a level 1 pediatric trauma center.
Results: Of 345 patients with cmTBI, the composite outcome occurred in 16 patients (4.6%). At a cutoff score of 2, the CHIIDA predicted the composite outcome with a sensitivity of 94% (95% CI 67-99%) and specificity of 69% (95% CI 64-74%), similar to the original study. Using the same cutoff score for PICU triage resulted in 48 (71%) more patients admitted to PICU.
Conclusions: In our cohort, the CHIIDA predicted the composite outcome well. If applied as a triage tool, it would have resulted in increased unnecessary PICU admissions.
Level of Evidence: Level III, prognosis.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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