Childhood trauma. Now and in the new millennium

Management of pediatric blunt abdominal trauma with split liver or spleen injuries: a retrospective study

BACKGROUND

Blunt abdominal trauma is a prevailing cause of pediatric morbidity and mortality. It constitutes the most frequent type of pediatric injuries. Contrast-enhanced sonography (CEUS) and contrast-enhanced computed tomography (CECT) are considered pivotal diagnostic modalities in hemodynamically stable patients.

AIM

To report the experience in management of pediatric split liver and spleen injuries using CEUS and CECT.

PATIENTS AND METHODS

This study included 246 children who sustained blunt abdominal trauma, and admitted and treated at three tertiary hospitals in the period of 5 years. Primary resuscitation was offered to all children based on the advanced trauma and life support (ATLS) protocol. A special algorithm for decision-making was followed. It incorporated the FAST, baseline ultrasound (US), CEUS, and CECT. Patients were treated according to the imaging findings and hemodynamic stability.

RESULTS

All 246 children who sustained a blunt abdominal were studied. Patients' age was 10.5 ± 2.1. Road traffic accidents were the most common cause of trauma; 155 patients (63%). CECT showed the extent of injury in 153 patients' spleen (62%) and 78 patients' liver (32%), while the remaining 15 (6%) patients had both injuries. CEUS detected 142 (57.7%) spleen injury, and 67 (27.2%) liver injury.

CONCLUSIONS

CEUS may be a useful diagnostic tool among hemodynamically stable children who sustained low-to-moderate energy isolated blunt abdominal trauma. It may be also helpful for further evaluation of uncertain CECT findings and follow-up of conservatively managed traumatic injuries.

Evaluation of intra-abdominal solid organ injuries in children

AIM

In our study we investigated characteristics and degree of intra-abdominal solid organ injuries according to tomographic imaging in pediatric patients who presented to our emergency clinic with possible abdominal injuries and to whom US and/or abdominal tomography were applied.

MATERIALS AND METHODS

1066 pediatric patients were included in the study. The age, gender, injury localization, injury type, injury mechanism, abdominal US and CT results, and treatment specifics of patients were evaulated.

RESULTS

58.5% of cases were male. Average age of children was 7.1±4.6 70.8% of the injuries occured in the outdoors. As for injury type, 92.8% of the injuries were blunt and 7.2% were penetrating traumas. The most common mechanism of injury was motor vehicle accidents at 41.4%. The most common abdominal physical examination finding was tenderness with a prevelance of 67%. In patients with solid organ injury, liver injury was detected in 47% of patients, spleen injury was detected in 36% of patients and renal injury was detected in 17% of patients. Grade II injury was the most common grade. 96.5 of patients were provided conservative treatment and 3.5% of patients were treated surgically.

CONCLUSION

Solid organ injuries due to abdominal trauma in children are generally related to blunt trauma and are severe injuries. CT angio is an important imaging method for detecting solid organ injuries, classification of the injury and treatment determination. Greater than 90% of solid organ injuries in children can be treated successfully with conservative methods.

Cervical Spine Evaluation in Pediatric Trauma: A Review and an Update of Current Concepts

The clinical presentation and diagnostic workup in pediatric cervical spine injuries (CSI) are different from adults owing to the unique anatomy and relative immaturity. The current article reviews the existing literature regarding the uniqueness of these injuries and discusses the current guidelines of radiological evaluation. A PubMed search was conducted using keywords "paediatric cervical spine injuries" or "paediatric cervical spine trauma." Six hundred and ninety two articles were available in total. Three hundred and forty three articles were considered for the review after eliminating unrelated and duplicate articles. Further screening was performed and 67 articles (original articles and review articles only) related to pediatric CSI were finally included. All articles were reviewed for details regarding epidemiology, injury patterns, anatomic considerations, clinical, and radiological evaluation protocols. CSIs are the most common level (60%-80%) for pediatric Spinal Injuries (SI). Children suffer from atlantoaxial injuries 2.5 times more often than adults. Children's unique anatomical features (large head size and highly flexible spine) predispose them to such a peculiar presentation. The role of National Emergency X-Ray Utilization Study, United State (NEXUS) and Canadian Cervical Spine Rule criteria in excluding pediatric cervical injury is questionable but cannot be ruled out completely. The minimum radiological examination includes 2- or 3-view cervical X-rays (anteroposterior, lateral ± open-mouth odontoid views). Additional radiological evaluations, including computerized tomography (CT) and magnetic resonance imaging (MRI) are obtained in situations of abnormal physical examination, abnormal X-rays, inability to obtain adequate X-rays, or to assess cord/soft-tissue status. The clinical criteria for cervical spine injury clearance can generally be applied to children older than 2 years of age. Nevertheless, adequate caution should be exercised before applying these rules in younger children. Initial radiographic investigation should be always adequate plain radiographs of cervical spine. CT and MRI scans should only be performed in an appropriate group of pediatric patients.

Critical Violent Injury in the United States: A Review and Call to Action

OBJECTIVE

This review provides an overview of what is known about violent injury requiring critical care, including child physical abuse, homicide, youth violence, intimate partner violence, self-directed injury, firearm-related injury, and elder physical abuse.

DATA SOURCES

We searched PubMed, Scopus, Ovid Evidence-Based Medicine Reviews, and the National Guideline Clearinghouse. We also included surveillance data from the Centers for Disease Control and Prevention and National Trauma Data Bank.

STUDY SELECTION

Search criteria limited to articles in English and reports of humans, utilizing the following search terms: intentional violence, intentional harm, violence, crime victims, domestic violence, child abuse, elder abuse, geriatric abuse, nonaccidental injury, nonaccidental trauma, and intentional injury in combination with trauma centers, critical care, or emergency medicine. Additionally, we included relevant articles discovered during review of the articles identified through this search.

DATA EXTRACTION

Two hundred one abstracts were reviewed for relevance, and 168 abstracts were selected and divided into eight categories (child physical abuse, homicide, youth violence, intimate partner violence, self-directed injury, firearm-related injury, and elder physical abuse) for complete review by pairs of authors. In our final review, we included 155 articles (139 articles selected from our search strategy, 16 additional highly relevant articles, many published after we conducted our formal search).

DATA SYNTHESIS

A minority of articles (7%) provided information specific to violent injury requiring critical care. Given what is known about violent injury in general, the burden of critical violent injury is likely substantial, yet little is known about violent injury requiring critical care.

CONCLUSIONS

Significant gaps in knowledge exist and must be addressed by meaningful, sustained tracking and study of the epidemiology, clinical care, outcomes, and costs of critical violent injury. Research must aim for not only information but also action, including effective interventions to prevent and mitigate the consequences of critical violent injury.

Factors associated with patient exposure and environmental control during pediatric trauma resuscitation

BACKGROUND

Exposure and environmental control are essential components of the advanced trauma life support primary survey, especially during the resuscitation of pediatric patients. Proper exposure aids in early recognition of injuries in patients unable to communicate their injuries, while warming techniques, such as the use of blankets, assist in maintaining normothermia. The purpose of this study was to identify factors associated with exposure compliance and duration during pediatric trauma resuscitation.

METHODS

All pediatric trauma resuscitations over a 4-month period were reviewed for compliance and time to completion of clothing removal and warm blanket placement. Video review data were then linked with clinical data obtained from the trauma registry. Univariate and multivariate analyses were used to determine the associations of patient characteristics, injury mechanism, and clinical factors on exposure compliance and duration.

RESULTS

Of 145 patients, 65 (52%) were never exposed. Lower exposure compliance was associated with increasing age (odds ratio, [OR], 0.90; 95% confidence interval [CI], 0.83-0.98), Glasgow Coma Scale (GCS) score of 14 or greater (OR, 0.16; 95% CI, 0.03-0.76), Injury Severity Score (ISS) of 15 or less (OR, 0.27; 95% CI, 0.09-0.82), and the absence of head injury (OR, 0.26; 95% CI, 0.08-0.87). Among those exposed, the duration of exposure was longer among children with GCS score of less than 14 (4.3 [1.6], p = 0.009), head injuries (3.33 [1.6], p = 0.04), and the need for intubation (8.4 [2.2], p < 0.001). In multivariate analyses, older age and ISS of 15 or less were associated with a decreased odds of exposure (p = 0.009, p = 0.04, respectively), while intubation was associated with increased exposure duration (p = 0.007).

CONCLUSION

Despite the importance of exposure and environmental control during pediatric trauma resuscitation, compliance with these tasks was low, even among severely injured patients. Interventions are needed to promote the proper exposure of patients during the initial evaluation, while also limiting the duration of exposure during examinations and procedures in the trauma bay.

LEVEL OF EVIDENCE

Epidemiologic study, level III.

Chiropractic care of a 6-year-old girl with neck pain; headaches; hand, leg, and foot pain; and other nonmusculoskeletal symptoms

OBJECTIVE

The purpose of this case report is to describe the response to chiropractic care of a pediatric patient with complaints of neck pain; headaches; and hand, leg, and foot pain after head trauma and the reports of changes in the patient's history of chronic fatigue, vomiting, and coughing.

CLINICAL FEATURES

A 6-year-old girl was pushed into a playground slide, hitting her head and resulting in acute complaints of her "neck and brain hurting" and hand, foot, and occasional leg pain. In addition, the patient had a several-year history of unexplained fatigue, vomiting, and coughing spells. She had a neck pain disability index of 17.8%; left lateral and rotational head tilt; cervical antalgic lean; loss of cervical range of motion; anterior cervical translation; and spasm, tenderness, trigger points, and edema along the cervical and thoracic spine.

INTERVENTION AND OUTCOME

The patient was cared for using Activator Methods protocol. After the fifth treatment, all the patient's symptoms dissipated, with a complete return to normal activity and spinal stability after 9 treatments. At 19 weeks, her spine continued to be asymptomatic; and her neck disability index was 0%.

CONCLUSION

This case demonstrated that the Activator Method of chiropractic care had a beneficial effect for this pediatric patient.

BLUNT CHEST TRAUMA IN CHILDHOOD

BACKGROUND

Although thoracic injuries are uncommon in children, their rate of morbidity and mortality is high. The aim of this study was to evaluate the clinical features of children with blunt chest injury and to investigate the predictive accuracy of their paediatric trauma scores (PTS).

METHODS

Between September 1996 and September 2006, children with blunt thoracic trauma were evaluated retrospectively. Clinical features and PTS of the patients were recorded.

RESULTS

There were 27 male and 17 female patients. The mean age was 7.1 +/- 3.4 years, and the mean PTS was 7.6 +/- 2.4. Nineteen cases were injuries caused by motor vehicle/pedestrian accidents, 11 motor vehicle accidents, 8 falls and 6 motor vehicle/bicycle or motorbike accidents. The following were noted: 28 pulmonary contusions, 12 pneumothoraxes, 10 haemothoraxes, 9 rib fractures, 7 haemopneumothoraxes, 5 clavicle fractures and 2 flail chests, 1 diaphragmatic rupture and 1 pneumatocele case. The cut-off value of PTS to discriminate mortality was found to be < or = 4, at which point sensitivity was 75.0% and specificity was 92.5%. Twenty-seven patients were treated non-operatively, 17 were treated with a tube thoracostomy and two were treated with a thoracotomy. Four patients who suffered head and abdominal injuries died (9.09%).

CONCLUSION

Thoracic injuries in children expose a high mortality rate as a consequence of head or abdominal injuries. PTS may be helpful to identify mortality in children with blunt chest trauma. Blunt thoracic injuries in children can be treated with a non-operative approach and a tube thoracostomy.

Population-based study of paediatric head injury

AIM

There is a paucity of population-based studies regarding the spectrum of paediatric head injury from mild through serious to fatal paediatric head injury. The aims of the present study were to determine the incidence, demographics and outcome of significant head injury in a state-wide population of children aged 0-15 years. A secondary aim was to determine if any serious head injuries were being missed under the current management protocols of the state-wide trauma system.

METHODS

A retrospective review of significant head injury in all paediatric patients over a period of 2 years was undertaken. Data were collected from the Victorian State Trauma Outcome Registry and Monitoring database, the Victorian Emergency Minimum Dataset and from the Victorian Institute of Forensic Medicine.

RESULTS

The incidence of paediatric head injury in Victoria over the 2-year period was 765 per 100000 per year. The incidence of admitted head injuries was 75 per 100000 per year and the incidence of significant head injury was seven per 100000 or 151 children. Forty-one per cent of these injuries required surgical intervention. Mortality was 1.6 children per 100000. All patients who died presented with a Glasgow Coma Score (GCS) of 3 and had multiple other risk factors. There were no deaths in patients discharged from hospital. Demographic and clinical factors associated with higher mortality and morbidity was determined.

CONCLUSION

The incidence of significant paediatric head injury was low. Deaths occurred early and were always associated with significant early clinical features of severe head injury. This highlights the importance of strategies for the prevention of head injuries. There appeared to be no serious head injuries missed during the study period.

Complications of pediatric trauma: effects on pediatric trauma anesthesia

Pediatric trauma is a significant problem worldwide. The complications of pediatric trauma affect the emergency medical services provider, emergency physician, trauma surgeon, and anesthesiologist in different and challenging ways. Children have unique airway concerns, and require distinctive and safe approaches to protection of the airway. Moreover, the resuscitation of infants, children, and adolescents involved in trauma is complex and can be stressful for many caregivers. Therefore, the provision of anesthesia for acute pediatric trauma requires a synthesis of the usual issues of pediatric anesthesia with the overlying complications of trauma to effect an ideal anesthetic technique for each patient.

Pediatric Trauma Deaths: A Three-Part Analysis from a Nonacademic Trauma Center

A three-part analysis was undertaken to assess pediatric trauma mortality in a nonacademic Level II trauma center at Parkview Hospital in Fort Wayne, Indiana. Part I was a comparison of Parkview trauma registry data collected from 1999 through 2003 with those of pediatric and adult trauma centers in Pennsylvania. The same methodology used in Pennsylvania was used for the initial evaluation of pediatric deaths from trauma in our trauma center. Part II was a formal in-depth analysis of all individual pediatric deaths as well as surgical cases with head, spleen, and liver injuries from the same time frame. Part III proposes a new methodology to calculate a risk-adjusted mortality rate based on the TRISS model for the evaluation of a trauma system. The use of specific mortality and surgical intervention rates was not an accurate reflection of trauma center outcome. The proposed risk-adjusted mortality rate calculation is perhaps an effective outcome measure to assess patient care in a trauma system.

Pediatric trauma susceptibility to sepsis

OBJECTIVE

The purpose of this review is to review how pediatric trauma may predispose children to sepsis.

DESIGN

The information discussed in this report is derived from a recent literature review of pediatric trauma and related topics and discussion at an international consensus conference on pediatric sepsis.

MEASUREMENTS AND MAIN RESULTS

There is a paucity of evidence on sepsis-related complications in pediatric trauma patients. Severe traumatic brain injury is a leading predisposing factor for sepsis complications. Excluding burn trauma, traumatically injured children without severe head injury rarely succumb to overwhelming sepsis.

CONCLUSIONS

Patients with multiple traumatic injuries are frequently admitted to the intensive care unit, and because head injury is the most common ailment, unconscious patients with a combination of injuries that include head injury will regularly require mechanical ventilation and central venous access and are at risk for life-threatening nosocomial infections. Outside of pulmonary contusions, organ-specific causes of infection are infrequent.

Paediatric prehospital trauma

The commonest cause of death in children is trauma, yet few studies have been undertaken to study their needs in the prehospital setting. This article examines the problems associated with seriously traumatized children in the prehospital setting and reviews their management with reference to the specific differences between adults and children. A systematic review of the primary survey is made. Other important aspects of their care including equipment, analgesia, child abuse and accident prevention are also discussed. The need for further research in this field to allow children to enjoy the standard of care afforded adults is emphasized.

Gender and age effects on outcome after pediatric traumatic brain injury

OBJECTIVE

To evaluate whether girls have better outcomes after traumatic brain injury than boys.

DESIGN

Retrospective cohort study.

SETTING

University hospital.

PATIENTS

A 16,586 patient subset of the National Pediatric Trauma Registry with nonpenetrating traumatic brain injury.

INTERVENTIONS

Retrospective review.

MEASUREMENTS AND MAIN RESULTS

The patients were subdivided by age into prepubertal (0-7 yrs), indeterminate pubertal (8-12 yrs), and probable pubertal (13-19 yrs). All analyses were adjusted for injury severity using the Injury Severity Score. Outcome variables were in-hospital death rate, intensive care unit length of stay, total length of stay, discharge to home vs. rehabilitation, and functional status at discharge. Overall, 6.1% of girls and 5.3% of boys died. A higher proportion of girls were injured in motor vehicle crashes. Gender did not have a significant effect on in-hospital mortality rate after adjustment for age, Injury Severity Score, and motor vehicle crashes. Boys had a shorter intensive care unit length of stay (p =.027). There were no statistically significant differences between boys and girls in total hospital length of stay, functional outcome, and discharge location, although for every outcome there was a trend toward girls doing worse.

CONCLUSIONS

There is evidence from this large study that girls do not have a better outcome after pediatric traumatic brain injury than boys, with a suggestion that girls may do worse.

The South African experience with ingestion injury in children

INTRODUCTION

The Red Cross Children's Hospital is the only children's hospital in South Africa. It has a dedicated trauma unit for all children under the age of 13 and serves a population of approximately 2 million inhabitants. As part of the Child Accident Prevention Foundation program we have kept a database of all children treated for trauma in our hospital since 1991. Presently, we have over 88,000 entries in our database.

AIM

To study our experience with ingested foreign bodies in children.

MATERIALS AND METHODS

A retrospective study was performed using the CAPFSA database of a total of 3677 patients presenting with foreign bodies. The hospital folders were searched using a standardised data extraction form. Only foreign bodies aspirated or ingested were included.

RESULTS

To date, 241 folders have been analysed.

DEMOGRAPHICS

Both sexes were equally affected (boys 49%). Age ranged between 0 and 12 years, although there was only one child under the age of 1. At the age of 3 years there was a peak in incidence (24% of all cases). Nature of ingested object: Although the objects were from a range of materials, most were metal (40%) or plastic (23%). The most commonly ingested object was a coin (28%), a ball (20%) or bone (8%). The size ranged from 0.1 to 3 cm (as measured by virtual ring), the most common size of an ingested foreign body was 0.5 cm. Anatomical site: The most common anatomical site of impaction was the nose (41%), followed by the oesophagus (20%), the stomach (14%) and bowel (11%). Other anatomical sites included hypopharynx, nasopharynx, bronchus, larynx and oral cavity. Severity of symptoms: Only 0.4% of our cases were assessed as being severe, 14% as moderate, and 44% as mild. Forty-two percent (42%) had no symptoms. Removal: Fifty-seven percent (57%) of ingested foreign bodies were removed surgically, 19% were left in situ, 14% spontaneously dislodged and only 1% was removed by Foley catheter manipulation.

CONCLUSION

A presentation with a foreign body is quite common in our patient population, representing approximately 4.2% of all our cases. The majority of ingested foreign bodies produced mild or no symptoms, needed surgical removal and had no complications.

Behavioural characteristics and accidents: findings from the Health Survey for England, 1997

This study analysed the relationship between major and minor accidents, and major accidents involving a moving vehicle, and behavioural and emotional factors in children, aged 4-15 years, using the Strengths and Difficulties Questionnaire (SDQ), and adjusting for demographic, socio-economic and family type factors. Data from a large representative national sample of about 6000 children were analysed using simple and multiple logistic regression. The analysis shows that the prevalence of SDQ scales, such as hyperactivity and conduct disorder were significantly higher in boys, lower social classes and step- and single-parent families. After adjusting for the demographic, socio-economic and family type factors, children who scored borderline or high for hyperactivity were almost two times more likely to report having major accidents. Children who scored high for hyperactivity and emotional symptoms were one and a half times more likely to report having minor accidents. For major accidents involving moving vehicles, the relationships with the behavioural and emotional factors were generally stronger than for major accidents in general. Hyperactivity, in particular, was significantly associated with the occurrence of major and minor accidents, and major accidents involving moving vehicles. The behavioural risk factors were significantly more common in the lower social classes, families receiving benefits and step- and single-parent families.

Pediatric trauma systems

The origins of trauma systems in the United States date to the 1960s when physicians returning from wars abroad realized that lessons learned from managing military casualties could be applied to civilian traumatic injury. Over the next several decades, trauma centers and then trauma systems began to be developed in an attempt to improve prehospital and acute care for these patients. Although studies of trauma system effectiveness are fraught with methodologic difficulties, several types of studies (panel reviews of preventable deaths, registry studies, and population-based studies), suggest that there may be improvements in mortality when trauma systems are established. Further study needs to focus on other outcomes than mortality, such as return to function after rehabilitation. Pediatric trauma systems have by necessity developed within the "adult" systems in place. The history of pediatric system development and studies assessing outcomes are also discussed. Continued system development, assessment, and educational efforts about how childhood injuries are different are essential to combat this leading killer of children.

Pediatric trauma: postinjury care in the pediatric intensive care unit

Traumatic injuries occur in > 20 million children each year and are the leading source of death in children over the age of 1 yr. Mechanisms of injury and subsequent therapies for critically injured children are diverse. This review will focus on resources and management strategies for caring for the severely injured child in the pediatric intensive care unit.

Sudden death in an infant resulting from torsion of the uterine adnexa

A 2-month-old infant girl died suddenly as a result of torsion of the uterine adnexa. The infant was found unresponsive in bed and was pronounced dead shortly after her arrival at a hospital. There were no antecedent signs of illness. At autopsy, the right ovary and right fallopian tube were twisted and were dark purple, swollen, and necrotic. The right ovary was enlarged by a follicle cyst 4 cm in diameter, which likely precipitated the torsion. The mechanism of death was unclear but may have resulted from the release of cytokines produced in response to necrotic adnexal tissue. Fatal uterine adnexal torsion has been reported rarely in infants; in all those cases there were antecedent symptoms. Torsion of the uterine adnexa should be included in the differential diagnosis of sudden death in infancy.

A new method for estimating probability of survival in pediatric patients using revised TRISS methodology based on age-adjusted weights

BACKGROUND

TRISS methodology estimates probability of survival (P(s)) based on coefficients derived largely from adult data. We developed a novel pediatric age-specific method to estimate P(s).

METHODS

The Pennsylvania Trauma Outcome Study database was queried for pediatric patients injured between 1993 and 1996 (n = 9730). P(s) derived from the Pediatric Age-Adjusted TRISS (PAAT) methodology was generated using our Age-Specific Pediatric Trauma Score and Injury Severity Score with corresponding weights. A test data set of 7138 pediatric patients entered in the Pennsylvania Trauma Outcome Study from 1997 to 1999 was used to compute an expected number of survivors for PAAT, TRISS, and ASCOT (A Severity Characteristic of Trauma). Observed and expected survival were compared for blunt injured patients, for head injured patients, and by age category.

RESULTS

PAAT showed no significant difference between observed and expected survival. TRISS and ASCOT significantly underestimated overall survival: across age groups, for blunt injuries, for head injuries, and for patients whose P(s) was less than 91%.

CONCLUSION

PAAT offers a more reliable methodology than TRISS and ASCOT for comparing pediatric trauma outcomes.

Pedestrian road traffic collisions in South Africa

Pedestrian road traffic collisions continue to account for a large number of the clients attending the accident & emergency units in South Africa. These victims include both adults and children, and can lead to serious lifelong consequences for the victims and their families. A pilot study was carried out in Durban, KwaZulu-Natal in order to investigate the injuries sustained by pedestrian paediatric clients who were involved in road traffic collisions in South Africa. The findings of the study reflecting the age, gender distribution and the injuries and their severity are discussed.

The synergistic relationship between a level I trauma center and a regional pediatric trauma center

A regional pediatric trauma center and a level I trauma center with pediatric commitment in the same city developed a synergistic relationship addressing all aspects of care for pediatric trauma patients. Although it is unlikely that this model could be used in its entirety by all similar institutions, the principles may prove helpful in creating guidelines and relationships. Categorization, optimal use of resources, timely transportation of seriously injured children to the appropriate facility, and maintaining urgent care capabilities of each institution to care for seriously injured children are imperative. The combined effort resulted in our level I trauma center being verified by the American College of Surgeons and designated by our state Health Department as meeting all the criteria for pediatric trauma care. This experience should encourage every pediatric trauma center located in a children's hospital to become a regional pediatric trauma center. The real benefit from the relationship is that injured children receive optimal care at both institutions.

Development of a novel age-specific pediatric trauma score

BACKGROUND/PURPOSE

Trauma scoring systems are needed to provide efficient triage of injured patients and to assess differences in outcomes and quality of care between different trauma centers. Current scoring systems used in pediatric trauma are not age specific, and thus have significant limitations.

METHODS

The authors queried the Pennsylvania Trauma Outcome Study for all children 0 to 16 years entered in the database from 1993 to 1996. Age-specific threshold values for systolic blood pressure, pulse, and respiratory rate were established. Using coded scores for these age-specific values and Glasgow Coma Scale, an age-specific pediatric trauma score (ASPTS) was derived. Triage ASPTS (T-ASPTS) consisted of the integer sum of coded scores for the 4 variables, whereas ASPTS was calculated using weighted coefficients derived from logistic regression for each variable.

RESULTS

T-ASPTS correlated with mortality rate. Using a threshold score of less than 10, T-ASPTS predicted mortality rate with a sensitivity of 96.97% and a specificity of 88.83%. T-ASPTS predicted mortality rate and percentage of patients with Injury Severity Score greater than 20 with similar sensitivity to the Revised Trauma Score (RTS), but T-ASPTS was more specific. The ASPTS predicted probability of survival more accurately than the RTS.

CONCLUSIONS

ASPTS performs favorably as both a triage score and as a tool for predicting probability of survival for outcomes analysis. Further comparisons to existing trauma scores are needed to verify the utility of ASPTS.