The Performance of the Pediatric Trauma Score in a Pediatric Emergency Department: A Prospective Study

Abstract

Introduction:The aim of this study was to assess the efficacy of the Pediatric Trauma Score (PTS) in predicting significant trauma in patients presenting with blunt trauma to a high-level pediatric emergency department. Methods: Patients younger than 15 years of age presenting to the pediatric emergency department of the Tepecik Training and Research Hospital with acute high-energy blunt trauma were analyzed prospectively. The PTS was calculated on arrival at the pediatric emergency department. The patients were classified into two groups as follows: patients with a PTS of ≤8 comprised the significant trauma group, while patients with a PTS of >8 made up the non-significant trauma group. Results: Two-hundred-thirteen children with a mean age of 6.1±3.9 years (range: 10 days-15 years) were included in the study. The frequency of coagulation testing and thorax computed tomography in the pediatric emergency department, need for critical interventions and therapies in the pediatric emergency department, rate of hospitalization, need for transfer to the pediatric intensive care unit, mechanical ventilation, operation, blood transfusion, and mortality rate were statistically higher in the significant trauma group (p<0.05). PTS ≤8 exhibited a sensitivity of 56.2% and a specificity of 90.8% for hospitalization (AUROC: 0.682; 95% confidence interval: 0.610-0.755). The PTS was significantly correlated with length of hospital stay (r=-0.493; p<0.001) and length of observation in the pediatric emergency department (r=-0.442; p<0.01). Conclusion: PTS on arrival at a high-level pediatric emergency department is a good predictor of the need for critical interventions/ therapies and mortality in children with high-energy blunt trauma. However, its accuracy is moderate for the prediction of hospitalization. Keywords: Pediatric Trauma Score, high-energy trauma, mortality, hospitalization Amaç: Çalışmanın amacı, üst düzey bir çocuk acil servisine künt yüksek enerjili travma nedeniyle başvuran çocuklardaki ciddi travmayı öngörmede, Pediyatrik Travma Skoru'nun (PTS) etkin olup olmadığının araştırılmasıdır. Yöntemler: Akut künt yüksek enerjili travma nedeniyle Tepecik Eğitim ve Araştırma Hastanesi'ne başvuran 15 yaşından küçük çocuklar ileriye yönelik olarak incelendi. PTS yaralı acil servise geldiği anda hesaplandı. Hastalar iki gruba ayrıldı: PTS ≤8 (ciddi travma) ve PTS >8 (ciddi olmayan travma). Bulgular: İki yüz on üç çocuk (ortalama yaş: 6,1±3,9 yıl; en küçük: 10 gün -en büyük: 15 yıl) çalışmaya alındı. Acil serviste koagülasyon testi ve toraks tomografisi sıklığı, acil serviste kritik girişim ve tedavi gereksinimi, hastaneye yatış oranı, yoğun bakım gereksinimi, mekanik ventilatör gereksinimi, ameliyat, kan transfüzyonu, ölüm sıklığı PTS ≤8 grubunda daha fazlaydı (p<0,05). PTS ≤8'in duyarlılığı %56,2; özgüllüğü %90,8 (AUROC: 0,682; %95 CI: 0,610-0,755) olarak hesaplandı. PTS hastanede yatış süresi (r=-0,493; p<0,001) ve acil serviste izlenme süresi (r=-0,442; p<0,01) ile anlamlı korelasyon göstermekteydi. Sonuç: Künt yüksek en...

Evaluation of Perfusion Index in Pediatric Trauma Patients

“…Transfusion rate was 6.6% in our study. Anıl et al [5] reported that they have transfused 7% of trauma patients which was similar to our study. While the mortality rate was 1.8% in Anıl et al's study, it was 4.4% in our study.…”

“…[ 9 , 10 ] In our study, 23% of patients were major trauma patients with PTS ≤8. Anıl et al[ 5 ] reported that major trauma patients’ rate was 32.3% in their study. The low rate in our study can be attributed to the fact that pediatric patients were not followed in surgical intensive care units of our hospital.…”

“…20.9% of the patients admitted to the pediatric intensive unit due to trauma received mechanical ventilator support. Anıl et al[ 5 ] found that 12.2% of trauma patients who were admitted to the PICU were intubated and connected to a mechanical ventilator. Compared to this study, the number of patients mechanically ventilated was higher in our study.…”

Determinants of Mortality and Intensive Care Requirement in Pediatric Thoracoabdominal Injuries

“…[ 20 ] There is a negative linear relationship between PTS and rates of mortality. [ 21 ] In the present study, PTS was found to be under three points in the mortality group.…”

Evaluation of Clinical and Radiological Indicators of Childhood Head Trauma

“…However, considering all traumas, it has a moderate effectiveness in predicting hospitalization. 14 PTS expresses the level of consciousness, age of the patient, skeletal injury level and airway patency by one number. 5 In our study, PTS was found as an effective scoring system in predicting traumatic brain injury, the risk for surgery and neurological sequalae in all age groups.…”