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A comparison of the trauma score, the revised trauma score, and the pediatric trauma score
M R Eichelberger1, C S Gotschall, W J Sacco
1Emergency Trauma Services, Children's National Medical Center, Washington, DC 20010.
Insights
The Trauma Score (TS), Revised Trauma Score (RTS), and Pediatric Trauma Score (PTS) are equally effective for identifying severely injured children in prehospital triage. Thresholds for each score offer comparable sensitivity and specificity for pediatric trauma assessment.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care
- Clinical Triage Tools
Background:
- Accurate identification of severely injured children is critical for effective prehospital care.
- Existing trauma scoring systems like the Trauma Score (TS), Revised Trauma Score (RTS), and Pediatric Trauma Score (PTS) are used for patient assessment.
- The comparative efficacy of these scores in pediatric populations requires further investigation.
Purpose of the Study:
- To compare the retrospective abilities of the TS, RTS, and PTS in identifying severely injured children.
- To determine optimal threshold values for each score to maximize sensitivity and specificity in pediatric trauma triage.
- To evaluate the utility of these scores for prehospital pediatric trauma assessment.
Main Methods:
- Calculated TS, RTS, and PTS for 1,334 pediatric blunt and penetrating trauma patients (0-14 years old) upon admission.
- Utilized Injury Severity Score (ISS) >15 and ISS ≥20 as criteria for severe injury.
- Computed sensitivity, specificity, and predictive values; determined threshold values for each score.
Main Results:
- No significant differences were found between the TS and PTS in identifying severe pediatric trauma.
- After adjusting for tachypnea in young children (0-3 years), the RTS showed no significant difference compared to TS and PTS.
- Established equally sensitive and specific triage thresholds: TS <15, RTS <12, and PTS <9.
Conclusions:
- The TS, RTS, and PTS demonstrate comparable performance in retrospectively identifying severely injured children.
- The identified threshold values (TS <15, RTS <12, PTS <9) are effective for pediatric prehospital triage.
- Consideration of factors beyond triage accuracy, such as quality assurance applications, may influence the choice of a pediatric triage tool.
Abstract:
We compared the abilities of the Trauma Score (TS), the Revised Trauma Score (RTS), and the Pediatric Trauma Score (PTS) to retrospectively identify severely injured children. TS, RTS, and PTS were computed on admission for 1,334 consecutive blunt and penetrating trauma victims 0 to 14 years old. Injury Severity Score values of more than 15 and 20 or more were used as the criteria indicating severe injury. Sensitivity, specificity, and positive and negative predictive values were computed. Threshold values were determined for each scale to maximize sensitivity and specificity. No significant differences were found between the TS and the PTS. After adjusting for rapid respirations among children 0 to 3 years old, no differences existed between the RTS and the other scores. TS of less than 15, RTS of less than 12, and PTS of less than 9 are equally sensitive and specific indicators for pediatric prehospital triage. Because of the similarity of the instruments tested, their performances in other areas, such as quality assurance, should be considered when selecting a pediatric triage tool.