1. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma Clinical and Research Institute of Emergency Children’s Surgery and Trauma, Moscow, Russia Russian National Research Medical University, Moscow, Russia Prognostic scales ISS-RTS-TRISS and APACHE II in decision support for treatment of children with trauma Irina V. Vasilyeva, Sergei B. Arseniev Ph.D., Sergey L.Shvirev Ph.D., Zarubina T.V. M.D.

2. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma Modern health care in children's traumatology is directed to: Prevention of trauma causes Timely rendering of medical care Objective assessment of trauma severity for treating patients with trauma Effective decision-making to select an adequate tactics of treatment Justified distribution of resources in a medical institution

3. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma Objective estimation of trauma severity is based on: objective estimation of injury severity objective estimation of patient’s state after trauma. This estimation has been done using ISS-RTS-TRISS (Boyd and colleagues in 1987), APACHE II (Knaus et al., 1985) and other scales. These scales allow to have an objective understanding of patient’s state severity and to find out an expected risk for death outcome

4. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma Prognostic scales also allow: to sort patients by injury severity to prescribe an adequate medical treatment for trauma patients to define the tactics of medical care for such patients

5. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma Research Goal: To study the effectiveness of these scales in supporting doctor’s decision while choosing tactics for treating children with severe mechanical trauma and to study a possibility to integrate the studied methodology into Hospital Information System MEDIALOG

6. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma Materials: Retrospective study 399 patients with trauma ( November 2009 - December 2011) Average age 9 ± 5 year 259 males (64,9%) 26 died (6,5%) Findings of anamnesis, initial examination, parameters of physiological and neurological status at admission and within the first 24 hours.

7. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma Criteria for including patients Criteria for excluding patients Presence of heavy traumatic damage Age up to 18 Staying in the anesthesiology and resuscitation department not less than twelve hours. Availability of all necessary data for calculating results of prognostic scales Signs of drowning Injuries received as a result of acute blood circulation disorders (ex.: rupture of vascular aneurysms) Gun-shot wounds Repeated admission to anesthesiology and resuscitation department

8. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma Research methods: Integration of prognostic scales into HIS environment Statistical assessment and statistical description in Excel and SPSS programs Evaluation of discrimination ability (ROC-curve) Evaluation of calibration ability (c-criterion of Hosmer-Lemeshow )

9. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma

10. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma

11. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma

12. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma Distribution of Probability for Death Outcomes

13. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma Research results of prognostic scales Prognostic scalesROC-curvec-criterion of Hosmer- Lemeshow Azp ISS-RTS-TRISS0,908±0,0290,951 APACHE II0,875±0,0380,012

14. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma Area under ROC- curve

15. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma Conclusion The automated calculation of scale parameters in Health Informatics System (HIS) has shown that the discussed technique is a quick and operative instrument for supporting clinical decision so as to reduce death outcomes in children with trauma. Our research has shown that ISS-RTS-TRISS prognostic scale has an outstanding discrimination ability and a significant calibration ability which can be used for prognostic assessment of outcomes in children with trauma. In spite of the fact that these APACHE II prognostic scale has shown an excellent discrimination ability, the calibration ability was not significant. Thus, ISS-RTS-TRISS scale can be recommended for assessing severity of injuries in children

16. Irina Vasilyeva, Moscow, Russia Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and Trauma Thank you for attention!