Pediatric Risk Indicator: An Objective Measurement of Childhood Injury Severity

INTRODUCTION The Pediatric Risk Index (PRI) uses established measures of physiologic derangement (Pediatric Trauma Score and Glasgow Coma Scale) and anatomic severity (Injury Severity Score) to identify those patients at risk of death, impairment, or extensive resource utilization. METHODS The PRI was evaluated by analysis of 5,345 patients entered into a multi-institutional pediatric trauma registry during 1993. PRI was calculated for each patient, and its distribution for survivors compared with those of fatalities. Analysis of this distribution identified a risk discriminant which was used to compare resulting cohorts by mortality, intensive care unit stay, and discharge impairment as measured by Functional Independence Measure. To evaluate the PRI's ability to identify unexpected outcome the records of 7,319 children injured in 1992 were then compared to the "standards" developed from the 1993 data. RESULTS Mortality distribution analysis identified a PRI > 1 as an indication of injury related risk. For mortality, intensive care unit stay, and discharge Functional Independence Measurement, there was a statistically significant difference (chi squared, p < 0.001) between the at-risk and no-risk populations. Comparison of 1992 experience demonstrated at least one potentially preventable death. CONCLUSIONS The PRI effectively identifies injured patients at risk for dying, impairment, or extensive intensive care unit care.