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Systematic review and need assessment of pediatric trauma outcome benchmarking tools for low-resource settings
Etienne St-Louis1, Jade Séguin2, Daniel Roizblatt3
1Centre for Global Surgery, McGill University Health Centre, Montreal, QC, Canada. etienne.st-louis@mail.mcgill.ca.
Insights
Existing pediatric trauma scores are not suitable for low-resource settings. A new, adaptable score is needed for accurate injury severity assessment in children in low- and middle-income countries (LMIC).
Area of Science:
- Pediatric trauma care
- Global health equity
- Injury epidemiology
Background:
- Trauma significantly impacts child mortality and disability globally, disproportionately affecting low- and middle-income countries (LMIC).
- Existing trauma scores are crucial for risk stratification but often require resources unavailable in LMIC.
- There is a critical need to adapt trauma scoring for pediatric patients in resource-limited environments.
Purpose of the Study:
- To systematically review and assess current pediatric trauma scores for their applicability in LMIC.
- To identify the limitations and criticisms of existing scores in resource-limited settings.
- To highlight the need for a new, adapted trauma score for pediatric patients in LMIC.
Main Methods:
- A systematic literature review was conducted using multiple databases (Embase, Medline, Cochrane).
- Search strategies were developed with a senior librarian.
- Articles were selected by two reviewers based on predefined criteria and underwent qualitative analysis.
Main Results:
- Identified pediatric trauma scores are suboptimal for LMIC due to reliance on specific diagnoses, inappropriate physiologic parameters, or inaccessible laboratory data.
- Current scores often fail to account for the unique physiological needs of pediatric patients.
- Inconsistent accessibility of laboratory data in LMIC further limits the utility of existing scores.
Conclusions:
- A significant gap exists in reliably estimating pediatric injury severity and predicting outcomes in resource-limited settings.
- An ideal pediatric trauma score for LMIC must be easily calculable using readily available point-of-care data.
- The score should be adaptable to the physiological variations across different pediatric age groups.
Introduction:
Trauma is a leading cause of mortality and disability in children worldwide. The World Health Organization reports that 95% of all childhood injury deaths occur in Low-Middle-Income Countries (LMIC). Injury scores have been developed to facilitate risk stratification, clinical decision making, and research. Trauma registries in LMIC depend on adapted trauma scores that do not rely on investigations that require unavailable material or human resources. We sought to review and assess the existing trauma scores used in pediatric patients. Our objective is to determine their wideness of use, validity, setting of use, outcome measures, and criticisms. We believe that there is a need for an adapted trauma score developed specifically for pediatric patients in low-resource settings.
Materials And Methods:
A systematic review of the literature was conducted to identify and compare existing injury scores used in pediatric patients. We constructed a search strategy in collaboration with a senior hospital librarian. Multiple databases were searched, including Embase, Medline, and the Cochrane Central Register of Controlled Trials. Articles were selected based on predefined inclusion criteria by two reviewers and underwent qualitative analysis.
Results:
The scores identified are suboptimal for use in pediatric patients in low-resource settings due to various factors, including reliance on precise anatomic diagnosis, physiologic parameters maladapted to pediatric patients, or laboratory data with inconsistent accessibility in LMIC.
Conclusion:
An important gap exists in our ability to simply and reliably estimate injury severity in pediatric patients and predict their associated probability of outcomes in settings, where resources are limited. An ideal score should be easy to calculate using point-of-care data that are readily available in LMIC, and can be easily adapted to the specific physiologic variations of different age groups.
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