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.

Pediatric Infectious Diseases Encountered During Wartime Part II: Infectious Diseases Complications in the Individual Pediatric Patient

“…Comparative evaluations have demonstrated similar performance to well-established trauma severity illness scores utilized in industrialized western nations: Pediatric RISk of Mortality (PRISMIII), Pediatric Index of Mortality 2 (PIM2), and the PEdiatric Logistic Organ Dysfunction (PELOD) score [9]. Similarly, BIG performed well compared to the New Injury Severity Score (NISS), TRauma and Injury Severity Score (TRISS), and Probability of Survival 2014 (PS14) scores in a pediatric population from Turkey and Syria [10]. Evaluating the newer BIG score and other pediatric trauma scoring systems for their ability to predict risk of infection could extend their utility.…”

Comparison of Scoring Systems for Mortality Prediction in Pediatric Multitrauma Patients

“…21 Sultanoğlu et al hypothesized that the BIG score was superior to RTS and PTS to predict the mortality ratio. 7 In the study conducted with pediatric blunt trauma patients, probability of survival was found to be high in patients with the BIG score <18. 22 In this research, a reverse linear correlation was detected between BIG score and mortality.…”

“…After base deficit, INR, and GCS were found to be significantly related to pediatric mortality after trauma, the BIG score was developed in 2011. 7 The BIG score has been used in adult trauma patients and has been found to be useful in accurately predicting mortality. 21 Sultanoğlu et al hypothesized that the BIG score was superior to RTS and PTS to predict the mortality ratio.…”

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].…”