Validation of the Pediatric Resuscitation and Trauma Outcome (PRESTO) model in injury patients in Tanzania

Elizabeth M Keating, Modesta Mitao, Arthi Kozhumam, Joao Vitor Souza, Cecilia S Anthony, Dalton Breno Costa, Catherine A Staton, Blandina T Mmbaga, Joao Ricardo Nickenig Vissoci, Elizabeth M Keating, Modesta Mitao, Arthi Kozhumam, Joao Vitor Souza, Cecilia S Anthony, Dalton Breno Costa, Catherine A Staton, Blandina T Mmbaga, Joao Ricardo Nickenig Vissoci

Abstract

Introduction: Sub-Saharan Africa has the highest rate of unintentional paediatric injury deaths. The Pediatric Resuscitation and Trauma Outcome (PRESTO) model predicts mortality using patient variables available in low-resource settings: age, systolic blood pressure (SBP), heart rate (HR), oxygen saturation, need for supplemental oxygen (SO) and neurologic status (Alert Verbal Painful Unresponsive (AVPU)). We sought to validate and assess the prognostic performance of PRESTO for paediatric injury patients at a tertiary referral hospital in Northern Tanzania.

Methods: This is a cross-sectional study from a prospective trauma registry from November 2020 to April 2022. We performed exploratory analysis of sociodemographic variables and developed a logistic regression model to predict mortality using R (V.4.1). The logistic regression model was evaluated using area under the receiver operating curve (AUC).

Results: 499 patients were enrolled with a median age of 7 years (IQR 3.41-11.18). 65% were boys, and in-hospital mortality was 7.1%. Most were classified as alert on AVPU Scale (n=326, 86%) and had normal SBP (n=351, 98%). Median HR was 107 (IQR 88.5-124). The logistic regression model based on the original PRESTO model revealed that AVPU, HR and SO were statistically significant to predict in-hospital mortality. The model fit to our population revealed AUC=0.81, sensitivity=0.71 and specificity=0.79.

Conclusion: This is the first validation of a model to predict mortality for paediatric injury patients in Tanzania. Despite the low number of participants, our results show good predictive potential. Further research with a larger injury population should be done to improve the model for our population, such as through calibration.

Keywords: ACCIDENT & EMERGENCY MEDICINE; PAEDIATRIC SURGERY; Paediatric A&E and ambulatory care; Paediatric intensive & critical care; TRAUMA MANAGEMENT.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Distribution of systolic blood pressure (A) and heart rate (B) according to age and in-hospital mortality. *p

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