Predictors of polytrauma outcome in children on the first day of treatment in ICU

The objective was to identify predictors of polytrauma outcome in children on the first day of treatment in ICU.

Materials and methods. Design – multicenter, cohort, retrospective, observational study. 225 children with polytrauma were examined. The average age of children was 10 (4–14) years. There were 148 (65.8%) boys. In 65.2% of cases, the injury was received as a result of a traffic accident, catatrauma occurred in 32.6% of polytrauma. The AIS score was 34 (25–48) and the PTS score was 5 (2.0–8.0). The duration of artificial lung ventilation was 12 (0–97) hours, and treatment in ICU – 5 (2–8) days. Death was in 14.2% of cases. 

Results. An increase in Glasgow Coma Scale (GCS) and SpO₂ by one unit (1 point, 1%) was found to reduce the risk of adverse outcome by 44% and 9%, respectively, and an increase in creatinine concentration and international normalized ratio by one unit increased the probability of patient death by 4.3 and 15.8 times, respectively. A mathematical formula was developed to assess the risk of an unfavorable outcome of polytrauma in children at the time of admission to the ICU: OR = exp (3.74–0.58 · [GCS score] – 0.09 · [SpO₂] + 0.06 · [Creatinine] + 2.62 · [INR]. Its accuracy is 96.4%; sensitivity 83.4%; specificity 98.7%.

Conclusion. Predictors of unfavorable outcome of polytrauma in children at admission to ICU are low scores on the Glasgow Coma Scale, severe hypoxemia, coagulopathy and kidney damage.

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