Evaluating Trauma Scores for Mortality Prediction in Pediatric Patients
Mehmet Akif Dündar1, Sedanur Tekin Can2, Başak Nur Akyıldız1
1Department of Pediatrics, Pediatric Intensive Care Unit, Erciyes University Faculty of Medicine, Kayseri, Türkiye.
Insights
The Injury Severity Score (ISS) and Revised Trauma Score (RTS) effectively predict mortality in pediatric trauma patients. ISS is the strongest predictor, aiding early risk assessment and clinical decisions.
Area of Science:
- Pediatric critical care medicine
- Trauma surgery
- Clinical epidemiology
Background:
- Multiple trauma in children presents significant mortality risks.
- Accurate prediction of mortality is crucial for effective pediatric trauma care.
Purpose of the Study:
- To evaluate the predictive effectiveness of various trauma scoring systems for mortality in pediatric multiple trauma patients.
- To determine optimal cut-off values for these scoring systems.
Main Methods:
- Methodological study involving 107 pediatric intensive care unit patients with multiple trauma.
- Analysis of demographic data, clinical parameters, and multiple trauma scores (RTS, PTS, GCS, AIS, ISS, PRISM-3, PELOD-2).
Main Results:
- Mortality rate was 14% (15 deaths).
- All trauma scores differed significantly between survivors and non-survivors.
- Injury Severity Score (ISS) and Revised Trauma Score (RTS) were independent predictors of mortality.
- ISS demonstrated the highest predictive accuracy (AUC 0.98).
Conclusions:
- ISS and RTS are valuable independent predictors of mortality in pediatric trauma.
- ISS is the strongest predictor, offering significant prognostic value.
- Integrating ISS and RTS can improve risk stratification and clinical decision-making in pediatric trauma care.
Abstract:
Objective: This study aimed to evaluate the effectiveness of various trauma scoring systems in predicting mortality in pediatric patients with multiple trauma and to determine their cut-off values. Materials and Methods: A methodological study was conducted on pediatric patients under 18 years of age admitted to the pediatric intensive care unit for multiple trauma. Demographic data, clinical parameters, and trauma scores, including the Revised Trauma Score (RTS), Pediatric Trauma Score (PTS), Glasgow Coma Scale (GCS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), Pediatric Risk of Mortality Score III (PRISM-3), and Pediatric Logistic Organ Dysfunction (PELOD-2), were collected and analyzed. Results: Among the 107 patients, there were 15 deaths (14%). Significant differences were observed between survivors and non-survivors in all trauma scores. Non-survivors had higher AIS, ISS, PRISM-3, and PELOD-2 scores, while survivors had higher PTS, RTS, and GCS scores (P < .001). In the multivariate binary logistic regression analysis, both ISS (odds ratio [OR] 1.060 [95% CI: 1.029-1.092], P < .001) and RTS (OR 0.059 [95% CI: 0.007-0.517], P =.011) were independently associated with mortality. Injury Severity Score demonstrated the highest area under the curve (AUC) value of 0.98 in the receiver operating characteristic (ROC) analysis. Conclusion: Both ISS and RTS were identified as independent predictors of mortality in pediatric trauma patients. Injury Severity Score was the strongest predictor, while RTS also provided significant prognostic value. Integration of these scores into early assessment may enhance risk stratification and support clinical decision-making in pediatric trauma care.
