Highlights
- •Benchmarking trauma outcomes supports quality improvement. The standard tool, the Injury Severity Score (ISS), is imperfect in predicting pediatric mortality.
- •The Pediatric Resuscitation and Trauma Outcome Score (PRESTO) has been validated in low-and-middle-income countries. PRESTO performs equally well to ISS in a high-income context but is simpler to derive.
Summary
Background
Benchmarking is crucial for quality improvement of trauma systems. The Pediatric Resuscitation
and Trauma Outcome (PRESTO) model allows risk-adjusted comparisons of in-hospital
mortality for pediatric trauma populations in under-resourced environments. Our aim
was to validate PRESTO in a high-resource setting using provincial Trauma Registry
(TR) data and compare it to the standard benchmarking model, the Injury Severity Score
(ISS).
Methods
This retrospective case-control study collected demographic, vital sign, and outcome
data from the TR for patients aged <16 years sustaining major trauma from 2013-2021.
The PRESTO model estimates predicted probability of in-hospital mortality (Pm) using
the age, heart rate, blood pressure, oxygen saturation, neurological status, and use
of airway supplementation. PRESTO was assessed by comparison of Pm in patients who
died and survived and comparison of area under the receiver-operator curve (AUROC)
with that of ISS. Statistical analysis was performed using R.
Results
We included 647 patients, of which 69 died in-hospital (11%). The cohort was 37% female,
with a median age of 8 and median ISS of 17. The median Pm for cases was significantly
higher compared to controls (1.0 vs 5.2x10-5, p < 0.001). The AUROC for PRESTO and ISS were not significantly different (0.819
and 0.816, respectively; p = 0.95).
Conclusion
PRESTO is valid in a resource-rich environment, such as a Canadian province. It performs
equally well to ISS but is simpler to derive. In the future, PRESTO may serve to benchmark
levels of in-hospital mortality within or across institutions over time across Canada.
Keywords
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Article info
Publication history
Accepted:
January 10,
2023
Received:
January 10,
2023
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
