ABSTRACT
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 >24â¯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.
Subject(s)
Brain Injuries, Traumatic/diagnosis , Clinical Decision Rules , Clinical Decision-Making/methods , Critical Care/methods , Intensive Care Units, Pediatric , Triage/methods , Adolescent , Brain Injuries, Traumatic/complications , Brain Injuries, Traumatic/mortality , Brain Injuries, Traumatic/therapy , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Prognosis , Retrospective Studies , Trauma Severity IndicesABSTRACT
A future global pandemic is likely to occur and planning for the care of critically ill children is less robust than that for adults. This review covers the current state of federal and regional resources for pediatric care in pandemics, a strategy for pandemic preparation in pediatric intensive care units and regions focusing on stuff, space, staff and systems, considerations in developing surge capacity and triage protocols, special circumstances such as highly infectious and highly lethal pandemics, and a discussion of ethics in the setting of pediatric critical care in a pandemic.
