Comparison of Trauma Scoring Systems in Pediatric Trauma Patients

Abstract

Introduction Trauma is one of the major causes of death among all age groups. It is the leading cause of death and disability among children older than 1 year of age (1). In addition to designing pre-hospital and hospital trauma organizations, taking meticulous preventive measures and providing public education are greatly important for efforts aimed at reducing trauma-related mortality (2). Initial assessment and management of multi-trauma patients is a difficult task requiring a rapid and systematic approach. According to the ATLS principles, injured patients are assessed and treated based on their vital signs, level of consciousness, and injury mechanism (3). Additionally, a variety of trauma severity scoring systems has been devised to predict trauma severity and to predict and prevent trauma-related death (4). Trauma severity scoring refers to the process of prediction and quantification of the risks associated with death, hospitalization, and discharge (5). Trauma severity scores assess trauma in terms of its anatomic and/or physiological properties. abbreviated injury scale (AIS) and injury severity score (ISS) take into account injury's anatomic Aim: We aimed to evaluate and compare the performance of BIG score (Base deficit, INR, GCS), pediatric trauma score, revised trauma score, injury severity score, new injury severity score (NISS) in mortality and stay intensive care unit. Materials and Methods: One thousand five hundred ten pediatric patients aged less than 18 years who were admitted to the emergency department with multi-trauma between 1 July 2012 and 1 July 2016 were included in the retrospective research. Demographic data, vital signs in the emergency department, trauma location, injury severity indexes and follow up of patients were examined. Results: One thousand five hundred ten patients were included, 40.5% were female and 59.5% were male. Mean age was 7.81±4.8; mortality was 4.2%. The best score to evaluate mortality was "probability of survival 2014 (PS14)". The best score to force the stay in ICU was found as NISS, the most sensitive system was NISS and PS14 (94.9%) and the most specific was NISS (86.7). PS14 was the first to evaluate the survival. In our research, 94.3% of patient had blunt trauma and 5.7% had penetrating trauma. PS14 was found the best score to determine survival and mortality for blunt trauma patients. Conclusion: Although all scoring systems appeared similarly predictive among pediatric trauma patients, The PS14 score was more predictive for mortality and survival, and the NISS score for the need of intensive care admission. The NISS score was the most predictive score for intensive care admission in blunt and penetrating traumas combined. Particularly the newly developed PS14 score can be used as a powerfully predictive scoring system for outcomes among all pediatric trauma patients, irrespective of trauma mechanism.

Characteristics of pediatric injuries due to road traffic accidents and their effects on mortality

“…Several trauma scoring systems were developed to reduce the rate of morbidity and mortality in children with trauma, including ISS and GCS [12]. After admission to the hospital, the main mortality risk factors include being male, under 15 years of age, and coma.…”

“…Scoring systems provide information about the relationship between treatment and outcomes [11]. Injury Severity Score (ISS) is the "gold standard" among anatomical injury severity indicators in the trauma population [12,13]. Glasgow Coma Score (GCS), one of the physiological scoring systems used in patient follow-up from the time of admission, is a simple, objective scoring system that can indicate consciousness level and is commonly used in the reliable evaluation of the degree of coma [14].…”

Comparison of Scoring Systems for Mortality Prediction in Pediatric Multitrauma Patients

“…11 A novel trauma score is BIG score that is composed of some clinic and laboratory values, and formulated by base deficit (B), international normalized ratio (I), Glasgow coma scale (G). For calculation of BIG score admission values of base deficit, international normalized ratio (INR), and GCS were used and scored as ( 7 The sample size was calculated for α ¼ 0.05 and β À 1 ¼ 80% by using easy receiver operating characteristic (ROC) program (as demonstrated in previous studies in the community). A minimum number of 48 patients were found to be needed for the study.…”

“…Trauma scores can be used to estimate trauma severity, probability of mortality, disability, and hospitalization in children. 6,7 In recent years, pediatric risk of mortality 3 (PRISM 3) score usually used for estimation of mortality ratio of critic patients in pediatric intensive care unit (PICU). 8 Trauma and mortality scoring systems have played a fundamental role in the improvement of trauma care; however, many doctors are unable to understand the priority of these systems.…”

“…8 Trauma and mortality scoring systems have played a fundamental role in the improvement of trauma care; however, many doctors are unable to understand the priority of these systems. 7 Certain estimation of trauma-related mortality of pediatric patients would accelerate emergency triage and make possible accurate treatment choices without loss of time. Although lots of scoring systems have been evolved to determine the mortality in pediatric patients, their restrictions include the difficulty in rating/scoring, requirement of trained staff, and lack of accuracy.…”