The pediatric trauma score as a predictor of injury severity in the injured child

AbstractThe aim of this study was to compare scoring systems for mortality prediction and determine the threshold values of this scoring systems in pediatric multitrauma patients. A total of 57 multitrauma patients referred to the pediatric intensive care unit from January 2020 to August 2021 were included. The pediatric trauma score (PTS), injury severity score (ISS), base deficit (B), international normalized ratio (I), Glasgow coma scale (G) (BIG) score, and pediatric risk of mortality 3 (PRISM 3) score were analyzed for all patients. Of the study group, 35% were females and 65% were males with a mean age of 72 months (interquartile range: 140). All groups' mortality ratio was 12.2%. All risk scores based on mortality prediction were statistically significant. Cutoff value for PTS was 3.5 with 96% sensitivity and 62% specificity; for the ISS, it was 20.5 with 92% sensitivity and 43% specificity; threshold of the BIG score was 17.75 with 85.7% sensitivity and 34% specificity; and 12.5 for PRISM 3 score with 87.6% sensitivity and 28% specificity. PTS, ISS, BIG score, and PRISM 3 score were accurate risk predictors for mortality in pediatric multitrauma patients. ISS was superior to PTS, PRISM 3 score, and BIG score for discrimination between survivors and nonsurvivors.

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A SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS) AND ORGAN DYSFUNCTION IN CHILDREN WITH ABDOMINAL TRAUMA

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2020-24-2-128-133 ◽

2020 ◽

Vol 24 (2) ◽

pp. 128-133

Author(s):

Andrey G. Anastasov ◽

A. V. Scherbinin

Keyword(s):

Organ Dysfunction ◽

Abdominal Trauma ◽

Injury Severity ◽

Invasive Mechanical Ventilation ◽

Pediatric Trauma ◽

Perioperative Period ◽

Total Leukocyte Count ◽

Abdominal Injuries ◽

Clinical Criteria ◽

Trauma Score

Introduction. To assess SIRS and organ dysfunction in children with abdominal trauma using generally accepted scales is an actual issue for today. Purpose. To verify clinical criteria for SIRS and organ dysfunction in children with abdominal injuries in the perioperative period. Material and methods. 18 patients, aged 6 -12, with injury of their abdominal organs were treated at the Kusch Pediatric Surgery Clinic ( Republican Children’s Clinical Hospital) in Donetsk in 2014-2019. 11 (61.1%) patients with isolated blunt abdominal trauma and injuries of parenchymal organs were taken into Subgroup 1; 7 (38.9%) patients with open abdominal organ trauma and multiple injuries of internal organs - into Subgroup 2. Assessment of mechanical injury severity and prognosis were made using Pediatric Trauma Score (Tepas J.J., 1985) and Revised Trauma Score (Fitzmaurice L.S. 1997). Shock syndrome gradations were made by the FEAST criteria (Fluid Expansion as Supportive therapy) (2017). Results. Nosological configuration of the injury (closed or open, isolated or multiple) as well as the volume and character of surgical intervention were used for defining SIRS severity in children with abdominal injuries. In the perioperative period, parameters characterizing the degree of disorders of vital organs served as unified criteria of organ dysfunction in children with abdominal trauma. Conclusion. Before surgery, the most informative indexes were: tachypnea RR > 18.0 per min, SpO2/FiO2 < 264, HR > 130.0 beats per min, total leukocyte count > 13.5∙109/L or <4.5∙109/L. In the postoperative period: need in the inotropic support of systolic BP within normal limits, invasive / non-invasive mechanical ventilation, oxygen >50% FiO2 to maintain SpO2> 92%, SpO2 / FiO2<264.

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Evaluation of Injury Severity: Review of the Most Commonly Used System for the Evaluation of Injury Severity in Traumatologic Patients

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto200310316-19 ◽

2003 ◽

Vol 10 (3) ◽

pp. 16-19 ◽

Cited By ~ 1

Author(s):

A Karlbauer ◽

R Woidke ◽

A Karlbauer ◽

R Woidke

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Pediatric Trauma ◽

Abbreviated Injury Scale ◽

Coma Scale ◽

Advantages And Disadvantages ◽

Revised Trauma Score ◽

Golden Standard ◽

Trauma Score

The most commonly used systems for the evaluation of injury severity in traumatologic patients are presented: Glasgo Coma Scale, Mangled Extremity Severity Score, Revised Trauma Score, Abbreviated Injury Scale, Injury Severity Score, Pediatric Trauma Score. Their advantages and disadvantages are given. At present Injury Severity Score is considered to be a «Golden Standard.

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The Pediatric Trauma Score as a Predictor of Injury Severity: An Objective Assessment

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-198804000-00001 ◽

1988 ◽

Vol 28 (4) ◽

pp. 425-429 ◽

Cited By ~ 118

Author(s):

JOSEPH J. TEPAS ◽

MAX L. RAMENOFSKY ◽

DANIEL L. MOLLITT ◽

BRUCE M. GANS ◽

CARLA DiSCALA

Keyword(s):

Injury Severity ◽

Objective Assessment ◽

Pediatric Trauma ◽

Trauma Score

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Delayed Diagnosis of Injury in Pediatric Trauma

PEDIATRICS ◽

10.1542/peds.98.1.56 ◽

1996 ◽

Vol 98 (1) ◽

pp. 56-62 ◽

Cited By ~ 1

Author(s):

Ronald A. Furnival ◽

George A. Woodward ◽

Jeff E. Schunk

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Injury Severity ◽

Pediatric Trauma ◽

Delayed Diagnosis ◽

Pediatric Intensive Care ◽

Injured Child ◽

Severity Scores ◽

Hospital Stays

Objective. To define the frequency and nature of delayed diagnosis of injury (DDI) in pediatric trauma. Design. Retrospective review. Setting. Tertiary pediatric trauma center. Methods. Medical records of 1175 pediatric trauma admissions from July 1, 1989, through June 30, 1992, were reviewed. Results. Fifty (4.3%) patients had 53 DDI. Fractures accounted for 38 DDI, most commonly of the extremities (total, 16). The delay until injury diagnosis ranged from 1 to 55 (median, 3) days. Patients with DDI had lower scores on the Glasgow Coma Scale, higher injury severity scores, and longer pediatric intensive care unit and hospital stays than patients without DDI. Patients with DDI more frequently required medical transport, emergent intubation, admission to the pediatric intensive care unit, and surgery. The DDI altered treatment for 68% of patients; 10 required surgery, including second operations for 6 children. Conclusions. DDI represents a failure of pediatric trauma care at all levels. The severely injured child is at the greatest risk of DDI. All pediatric patients with trauma warrant ongoing evaluation to identify initially unrecognized injuries.

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THE PEDIATRIC TRAUMA SCORE AND THE INJURY SEVERITY SCORE IN CHILDHOOD LIVER AND SPLEEN INJURY

Pediatric Emergency Care ◽

10.1097/00006565-198912000-00053 ◽

1989 ◽

Vol 5 (4) ◽

pp. 287

Author(s):

R. Saladino ◽

G. Fleisher

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Pediatric Trauma ◽

Trauma Score

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Considerations and Evaluations on Abdominal Trauma in Pediatric Age.

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v3i2.64 ◽

2019 ◽

Vol 3 (2) ◽

Author(s):

Agron Dogjani ◽

Kastriot Haxhirexha ◽

Edvin Selmani ◽

Hysni Bendo ◽

Amarildo Blloshmi ◽

...

Keyword(s):

Emergency Department ◽

Injury Severity Score ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Severity Score ◽

Injury Severity ◽

Pediatric Trauma ◽

Pediatric Age ◽

Predictive Tool ◽

Trauma Score

Background: Trauma is the leading cause of morbidity and mortality in pediatric age. Abdominal trauma is the third most frequent cause of trauma injuries in children. The purpose of our study is to discuss BATp epidemiology and its relationship with polytrauma, , to recognize and describe the mechanisms of blunt abdominal trauma in pediatric age and to identify the signs and symptoms that associate it. Material and methods: In this retrospective study we reviewed all patients with blunt abdominal trauma in pediatric age who presented in Emergency Department at the University Hospital of Trauma in Tirana, Albania in the period between December 1-st 2017 and June 24-th 2018. The sample in the study was taken randomly. The Injury Severity Score, Revised Trauma Score were used as important points to evaluate gravity of injuries, and method of treatment. The data was introduced in absolute and percentage values and Kendal's tau b correlation coefficient and the regression analysis was used to analyze and to find out any association among the dependent versus independent variable. The type of study is case control with two components; descriptive and analytical. Results: In the time period that we studied, about 25200 patients were presented in Emergency department and 6.68% of these cases were hospitalized. Most frequent causes were motor vehicle accidents (35.4%) and abdominal trauma comprised 25.8% of cases, whereas in children it comprised 13.7% of total pediatric trauma. We have found correlation between the injury severity score and complications rate (r = 0.254, n = 49, p <0.001), and injury severity score with length of hospital stay (r = 0279, n = 49, p <0.001). Conclusions: Blunt Abdominal Trauma in pediatric age is a serious threat to the health of the children. Their treatment should be carried out not only in tertiary trauma centers but in every regional hospital. The trauma score is very valuable to determine the gravity of the injury, method of treatment and is a predictive tool in trauma outcomes.

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