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Beyond survival: Early markers of poor outcome in pediatric trauma
Kubra Boydag Guvenc1, Ebru Guney Sahin1, Idris Abdullah Yılmaz1
1Health Science University, Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital, Department of Pediatric Intensive Care, Istanbul, Turkey.
Insights
The lactate/albumin ratio is a valuable early indicator for predicting poor outcomes in pediatric trauma patients. This biomarker, combined with clinical scores, aids in early risk stratification for better patient management.
Area of Science:
- Pediatric critical care medicine
- Trauma research
- Biomarker discovery
Background:
- Pediatric trauma patients face significant mortality and morbidity risks.
- Accurate prognostic tools are crucial for timely intervention and improved outcomes.
- Existing clinical scoring systems and laboratory markers require further evaluation for predictive accuracy.
Purpose of the Study:
- To assess the prognostic capability of clinical scoring systems and laboratory biomarkers in predicting mortality and morbidity in pediatric trauma.
- To identify reliable early indicators of adverse outcomes in critically injured children.
- To inform the development of enhanced risk stratification protocols for pediatric trauma care.
Main Methods:
- Retrospective analysis of 88 pediatric trauma patients in a tertiary PICU.
- Calculation of clinical scores (PRISM III, PELOD-2, SIPA, GCS, VIS) and measurement of lactate, procalcitonin, and albumin.
- ROC analysis to determine the predictive performance of scores and biomarkers for mortality and morbidity (defined as persistent organ dysfunction).
Main Results:
- The lactate/albumin ratio demonstrated the highest predictive value for mortality (AUC=0.828).
- Non-survivors and patients with sequelae exhibited significantly higher illness severity scores and elevated lactate-related markers.
- The lactate/albumin ratio showed a strong negative predictive value (NPV=95.6%) for morbidity.
Conclusions:
- Clinical severity scores and lactate-related biomarkers are associated with outcomes in pediatric trauma.
- The lactate/albumin ratio serves as a potent early predictor of mortality and morbidity.
- Integrating combined scoring and biomarker strategies can optimize early risk stratification in pediatric trauma care.
Background:
This study aimed to evaluate the prognostic value of clinical scoring systems and admission-based laboratory biomarkers in predicting mortality and morbidity among pediatric trauma patients.
Methods:
We conducted a retrospective analysis of 88 pediatric trauma patients admitted to a tertiary-level pediatric intensive care unit between August 2024 and July 2025. Patients who died within the first 24 h were excluded. PRISM III, PELOD-2, SIPA, GCS, and VIS scores were calculated on the day of admission. Laboratory parameters including lactate, procalcitonin, and albumin levels were recorded. Morbidity was defined as persistent organ-specific dysfunction at discharge. Receiver operating characteristic (ROC) analysis was used to evaluate predictive performance.
Results:
The overall mortality rate was 5.7 %, while 13.6 % of patients developed sequelae. Non-survivors had significantly higher PRISM III, PELOD-2, lactate, lactate/albumin ratio, and procalcitonin levels, along with longer PICU stay and greater need for mechanical ventilation and inotropic support. The lactate/albumin ratio showed the highest predictive value for mortality (AUC = 0.828). Patients with sequelae had significantly higher illness severity scores and elevated lactate-related markers. Transfusion needs were also more common in this group. Lactate/albumin ratio demonstrated strong negative predictive value (NPV = 95.6 %) for morbidity.
Conclusion:
Both clinical severity scores and lactate-related biomarkers were associated with mortality and morbidity in pediatric trauma patients. In particular, the lactate/albumin ratio emerged as a useful early indicator of poor outcomes. These findings support the incorporation of combined scoring and biomarker strategies into early risk stratification protocols in pediatric trauma care.
