Tilford et al identified factors associated with mortality for children with head injury. The authors are from the Universities of Arkansas and California at San Francisco.
Patient selection: pediatric patients admitted to pediatric intensive care units after head injury.
Parameters:
(1) low bicarbonate (<= 15 mmol/L)
(2) low potassium (<= 3 mmol/L)
(3) high glucose (> 200 mg/dL)
(4) fixed pupils
(5) Glasgow Coma Score <= 8 on admission
(6) vasoactive infusion
|
Parameter |
Odds Ratio |
95% CI |
p value |
|---|---|---|---|
|
low bicarbonate |
4.5 |
1.4 – 14.48 |
0.012 |
|
low potassium |
4.23 |
1.21 – 14.8 |
0.024 |
|
high glucose |
3.6 |
1.22 – 10.63 |
0.020 |
|
fixed pupils |
8.91 |
2.73 – 29.09 |
< 0.001 |
|
Glasgow Coma Score |
4.65 |
1.39 – 15.59 |
0.013 |
|
vasoactive infusion |
5.41 |
1.98 – 14.8 |
0.001 |
|
Parameter |
Finding |
Points |
|---|---|---|
|
serum bicarbonate |
<= 15 mmol/L |
1.504 |
|
|
> 15 mmol/L |
0 |
|
serum potassium |
<= 3 mmol/L |
1.442 |
|
|
> 3 mmol/L |
0 |
|
serum glucose |
> 200 mg/dL |
1.281 |
|
|
<= 200 mg/dL |
0 |
|
pupils |
both fixed |
2.188 |
|
|
not fixed |
0 |
|
Glasgow Coma Scale |
> 8 on admission |
1.539 |
|
|
<= 8 on admission |
0 |
|
vasoactive infusion |
given |
1.688 |
|
|
not given |
0 |
X =
= SUM(points for parameters present) – 5.065
probability of mortality =
= EXP(X) / (1 + EXP(X) =
= 1 / (1 + EXP((-1) * X))
Infants <= 1 year of age were noted to have a significantly higher mortality rate than for children > 1 year of age.
Purpose: To evaluate a child with head injuries for risk of mortality using the Pediatric Head Injury Mortality Score (PHIMS).
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general, Otolaryngology
Objective: severity, prognosis, stage
ICD-10: S06,
