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Trauma Scores and Their Prognostic Value for the Outcome Following Pediatric Polytrauma
Danielle S Wendling-Keim1, Anja Hefele1, Oliver Muensterer1
1Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.
Insights
The Injury Severity Score (ISS) and National Advisory Committee for Aeronautics (NACA) scores are more effective than the Pediatric Trauma Score (PTS) and Glasgow Coma Score (GCS) for predicting emergency surgery in pediatric polytrauma patients.
Area of Science:
- Pediatric Trauma Care
- Trauma Scoring Systems
- Emergency Medicine
Background:
- Pediatric polytrauma management presents unique challenges, as adult trauma scores are not always applicable to children.
- Accurate trauma severity assessment is crucial for optimal treatment and surgical decision-making in pediatric patients.
- The comparative utility of various trauma scores in pediatric polytrauma remains unclear.
Purpose of the Study:
- To evaluate the predictive value of the Injury Severity Score (ISS), Pediatric Trauma Score (PTS), National Advisory Committee for Aeronautics (NACA), and Glasgow Coma Score (GCS) in assessing polytraumatized children.
- To determine the most effective trauma score for predicting the need for emergency surgical interventions in pediatric polytrauma.
Main Methods:
- Retrospective analysis of 97 pediatric polytrauma patients (age 0-17 years) with an ISS ≥16.
- Assessment of pathological imaging findings and emergency surgery as outcome variables.
- Receiver operator characteristic (ROC) curve analysis to determine the predictive accuracy of each trauma score.
Main Results:
- Pathological cranial findings were observed in 35 patients, leading to interventions like craniectomy or intracranial pressure monitoring.
- Abdominal trauma occurred in 45 patients, with 16 requiring surgical treatment; thoracic injuries were present in 43 patients, necessitating drainage in 10.
- The Injury Severity Score (ISS) and NACA scores demonstrated the highest predictive accuracy for emergency surgery (0.732 and 0.683, respectively), outperforming GCS (0.246) and PTS (0.261).
Conclusions:
- The initial Injury Severity Score (ISS) and NACA scores are superior predictors of operative interventions and outcomes in pediatric polytrauma patients compared to PTS and GCS.
- These findings highlight the importance of selecting appropriate trauma scoring systems for accurate assessment and management of severe pediatric injuries.
Abstract:
Purpose: The management and prognostic assessment of pediatric polytrauma patients can pose substantial challenges. Trauma scores developed for adults are not universally applicable in children. An accurate prediction of the severity of trauma and correct assessment of the necessity of surgical procedures are important for optimal treatment. Several trauma scores are currently available, but the advantages and drawbacks for use in pediatric patients are unclear. This study examines the value of the trauma scores Injury Severity Score (ISS), Pediatric Trauma Score (PTS), National Advisory Committee for Aeronautics (NACA), and Glasgow Coma Score (GCS) for the assessment of the polytraumatized child. Methods: In a retrospective study, 97 patients aged 0-17 years who presented with polytrauma and an ISS ≥16 in the trauma bay were included in the study. Patient records including radiological studies were analyzed. Pathological imaging findings and emergency surgery were assessed as outcome variables and the predictive value of the trauma scores were analyzed using receiver operator characteristic (ROC) curves. Statistical significance was set at an alpha level of P ≤ 0.05. Results: In this study, 35 of the 97 studied children had pathological cranial computed findings. These either underwent craniectomy or trepanation or a parenchymal catheter was placed for intracranial pressure monitoring. Abdominal trauma was present in 45 patients, 16 of which were treated surgically. Forty-three patients arrived with thoracic injuries, 10 of which received a thoracic drainage. One child underwent an emergency thoracotomy. Predictive accuracy for emergency surgery calculated using receiver-operator characteristic (ROC) curves was highest for ISS and NACA scores (0,732 and 0.683, respectively), and lower for GCS (0.246) and PTS (0.261). Conclusion: In our study cohort, initial ISS and NACA scores better predicted operative interventions and outcome than PTS or GCS for polytraumatized pediatric patients.
