Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Clinical and Research Institute of Emergency Children’s Surgery and

Trauma, Moscow, RussiaRussian National Research Medical

University, Moscow, Russia

Prognostic scales ISS-RTS-TRISS and APACHE II in

decision support for treatment of children with

trauma

Irina V. Vasilyeva, Sergei B. Arseniev Ph.D. , Sergey L.Shvirev Ph.D. , Zarubina T.V.

M.D.

Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Modern health care in children's traumatology is directed to:

• Prevention of trauma causes • Timely rendering of medical care• Objective assessment of trauma severity

for treating patients with trauma • Effective decision-making to select an

adequate tactics of treatment • Justified distribution of resources in a

medical institution

Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Objective estimation of trauma severity is based on:

• objective estimation of injury severity • objective estimation of patient’s state after

trauma . This estimation has been done using ISS-RTS-TRISS (Boyd and colleagues in 1987), APACHE II (Knaus et al., 1985) and other scales.

These scales allow to have an objective understanding of patient’s state severity and to find out an expected risk for death outcome

Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Prognostic scales also allow:

• to sort patients by injury severity• to prescribe an adequate medical

treatment for trauma patients• to define the tactics of medical care for

such patients

Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Research Goal:

To study the effectiveness of these scales in supporting doctor’s decision while choosing tactics for treating children with severe mechanical trauma and to study a possibility to integrate the studied methodology into Hospital Information System MEDIALOG

Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Materials:

• Retrospective study• 399 patients with trauma ( November 2009 -

December 2011)• Average age 9 ± 5 year• 259 males (64,9%)• 26 died (6,5%)• Findings of anamnesis, initial examination,

parameters of physiological and neurological status at admission and within the first 24 hours.

Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Criteria for including patients

Criteria for excluding patients

•Presence of heavy traumatic damage •Age up to 18•Staying in the anesthesiology and resuscitation department not less than twelve hours.•Availability of all necessary data for calculating results of prognostic scales

•Signs of drowning •Injuries received as a result of acute blood circulation disorders (ex.: rupture of vascular aneurysms)•Gun-shot wounds•Repeated admission to anesthesiology and resuscitation department

Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Research methods:

• Integration of prognostic scales into HIS environment

• Statistical assessment and statistical description in Excel and SPSS programs

• Evaluation of discrimination ability (ROC-curve)

• Evaluation of calibration ability (c-criterion of Hosmer-Lemeshow )

Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Distribution of Probability for Death Outcomes

Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Research results of prognostic scales

Prognostic scales ROC-curve c-criterion of Hosmer-Lemeshow

Az p

ISS-RTS-TRISS 0,908±0,029 0,951

APACHE II 0,875±0,038 0,012

Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Area under ROC- curve

Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Conclusion

• The automated calculation of scale parameters in Health Informatics System (HIS) has shown that the discussed technique is a quick and operative instrument for supporting clinical decision so as to reduce death outcomes in children with trauma.

• Our research has shown that ISS-RTS-TRISS prognostic scale has an outstanding discrimination ability and a significant calibration ability which can be used for prognostic assessment of outcomes in children with trauma. In spite of the fact that these APACHE II prognostic scale has shown an excellent discrimination ability, the calibration ability was not significant. Thus, ISS-RTS-TRISS scale can be recommended for assessing severity of injuries in children

Irina Vasilyeva, Moscow, Russia

Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and

Trauma

Thank you for attention!