Two novel resource-based metrics to quantify pediatric trauma severity based on probability of requiring critical care and anesthesia services

Christopher W. Snyder, David J. Ciesla, Joseph J. Tepas, Nicole M. Chandler, Paul D. Danielson, Raquel Gonzalez, Kristin Partain, Nicholas Poulos, Etienne E. Pracht

Research output: Contribution to journalArticlepeer-review


BACKGROUND Mortality-based metrics like the International Classification of Diseases (ICD) Injury Severity Score (ICISS) may underestimate burden of pediatric traumatic disease due to lower mortality rates in children. The purpose of this study was to develop and validate two resource-based severity of injury (SOI) measures, then compare these measures and the ICISS across a broad age spectrum of injured patients. METHODS The ICISS and two novel SOI measures, termed ICD Critical Care Severity Score (ICASS) and ICD General Anesthesia Severity Score (IGASS), were derived from Florida state administrative 2012 to 2016 data and validated with 2017 data. The ICASS and IGASS predicted the need for critical care services and anesthesia services, respectively. Logistic regression was used to validate each SOI measure. Distributions of ICISS, ICASS, and IGASS were compared across pediatric (0-15 years), adult (16-64 years), and elderly (65-84 years) age groups. RESULTS The derivation and validation cohorts consisted of 668,346 and 24,070 emergency admissions, respectively. On logistic regression, ICISS, ICASS, and IGASS were strongly predictive of observed mortality, critical care utilization, and anesthesia utilization, respectively (p < 0.001). The mean ICISS was 10.6 for pediatric and 19.0 for adult patients (ratio, 0.56), indicating that the predicted mortality risk in pediatric patients was slightly over half that of adults. In contrast, the mean ICASS for pediatric and adult patients was 50.2 and 53.2, respectively (ratio, 0.94); indicating predicted critical care utilization in pediatric patients was nearly the same as that of adults. The IGASS comparisons followed comparable patterns. CONCLUSION When a mortality-based SOI measure is used, the severity of pediatric injury appears much lower than that of adults, but when resource-based measures are used, pediatric and adult burden of injury appear very similar. The ICASS and IGASS are novel and valid resource-based SOI measures that are easily calculated with administrative data. They may complement mortality-based measures in pediatric trauma. LEVEL OF EVIDENCE Level III, prognostic and epidemiological study.

Original languageEnglish (US)
Pages (from-to)636-641
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Issue number4
StatePublished - Oct 1 2020


  • Pediatric trauma
  • metrics
  • mortality
  • resource utilization
  • severity of injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


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