Scoring Tool to Predict Need for Early Video-Assisted Thoracoscopic Surgery (VATS) After Pediatric Trauma,World Journal of Surgery

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Scoring Tool to Predict Need for Early Video-Assisted Thoracoscopic Surgery (VATS) After Pediatric Trauma
World Journal of Surgery ( IF 2.3 ) Pub Date : 2023-08-31 , DOI: 10.1007/s00268-023-07141-y
Brian Kazempoor ₁ , Jeffry Nahmias ₁ , Isabel Clark ₁ , Sebastian Schubl ₁ , Michael Lekawa ₁ , Lourdes Swentek ₁ , Hari B Keshava ₁ , Areg Grigorian _{1,

2}

Affiliation

Background

No widely used stratification tool exists to predict which pediatric trauma patients may require a video-assisted thoracoscopic surgery (VATS). We sought to develop a novel VATS-In-Pediatrics (VIP) score to predict the need for early VATS (within 72 h of admission) for pediatric trauma patients.

Methods

The pediatric 2017–2020 Trauma Quality Improvement Program database was used and divided into two sets (derivation set using 2017–2019 data and validation set using 2020 data). First, multiple logistic regression models were created to determine the risk of early VATS for patients ≤ 17 years old. Second, the weighted average and relative impact of each independent predictor were used to derive a VIP score. We then validated the score using the area under the receiver operating characteristic (AROC) curve.

Results

From 218,628 patients in the derivation set, 2183 (1.0%) underwent early VATS. A total of 8 independent predictors of VATS were identified, and the VIP score was derived with scores ranging from 0 to 9. The AROC for this was 0.91. The VATS rate increased steadily from 12.5 to 32% then 60.5% at scores of 3, 4, and 6, respectively. In the validation set, from 70,316 patients, 887 (1.3%) underwent VATS, and the AROC was 0.91.

Conclusions

VIP is a novel and validated scoring tool to predict the need for early VATS in pediatric trauma. This tool can potentially help hospital systems prepare for pediatric patients at high risk for requiring VATS during their first 72 h of admission. Future prospective research is needed to evaluate VIP as a tool that can improve clinical outcomes.

中文翻译：

预测小儿创伤后早期电视辅助胸腔镜手术 (VATS) 需求的评分工具

背景

目前尚无广泛使用的分层工具来预测哪些儿童创伤患者可能需要电视辅助胸腔镜手术 (VATS)。我们试图开发一种新的儿科 VATS (VIP) 评分，以预测儿科创伤患者早期 VATS（入院 72 小时内）的需要。

方法

使用儿科2017-2020年创伤质量改进计划数据库并分为两组（使用2017-2019年数据的推导集和使用2020年数据的验证集）。首先，创建多重逻辑回归模型来确定 ≤ 17 岁患者早期 VATS 的风险。其次，使用每个独立预测变量的加权平均值和相对影响来得出 VIP 分数。然后，我们使用接受者操作特征 (AROC) 曲线下面积验证分数。

结果

在推导集中的 218,628 名患者中，有 2183 名 (1.0%) 接受了早期 VATS。总共确定了 8 个 VATS 独立预测因子，并得出了 VIP 评分，评分范围为 0 到 9。其 AROC 为 0.91。VATS 率从 12.5% 稳步上升到 32%，然后在 3、4 和 6 分时分别上升到 60.5%。在验证集中，70,316 名患者中，887 名（1.3%）接受了 VATS，AROC 为 0.91。