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The Prognostic Value of Trauma Score, Injury Severity Score, and Pediatric BIG Scores in Pediatric Firearm Injuries
Zeynep Tanyeli1, Şener Çınıçev2, Utku Özer1
1Department of Pediatrics, Pediatric Emergency Medicine Clinic.
Insights
The Revised Trauma Score (RTS) best predicts mortality in pediatric firearm injuries. Integrating trauma scores into EHRs can improve care for critically injured children.
Area of Science:
- Emergency Medicine
- Pediatric Trauma Care
- Injury Epidemiology
Background:
- Firearm injuries pose a significant threat to children, requiring immediate multidisciplinary care.
- Effective risk stratification is crucial for managing pediatric firearm trauma victims.
Purpose of the Study:
- To evaluate the predictive performance of four trauma scores for mortality in pediatric firearm injury patients.
- To identify the most accurate scoring system for predicting outcomes in this vulnerable population.
Main Methods:
- Retrospective cohort study of 353 pediatric firearm injury patients (ages 1-18) at a Turkish trauma center.
- Calculation and comparative analysis of Pediatric Trauma Score (PTS), Revised Trauma Score (RTS), Injury Severity Score (ISS), and Pediatric BIG (PBIG) scores.
- Multivariable regression analysis to determine independent predictors of mortality.
Main Results:
- The Revised Trauma Score (RTS) demonstrated the highest accuracy in predicting mortality (AUC: 0.991).
- RTS was the sole independent predictor of in-hospital mortality in multivariable analysis.
- Injury Severity Score (ISS) showed optimal accuracy for predicting intensive care unit admission.
Conclusions:
- The RTS is the most reliable tool for predicting mortality in pediatric firearm trauma.
- Integrating validated trauma scores like RTS and ISS into electronic health records can enhance patient management and resource allocation.
Introduction:
Firearm injuries represent a major cause of morbidity and mortality in pediatric emergency departments. Their management requires a multidisciplinary approach, including airway stabilization, circulatory support, hemostasis, resuscitation, and emergency surgical intervention. This study aimed to evaluate the predictive performance of the Pediatric Trauma Score (PTS), Revised Trauma Score (RTS), Injury Severity Score (ISS), and Pediatric BIG (PBIG) score for mortality.
Materials And Methods:
This retrospective cohort study was conducted at a high-volume, urban, tertiary care, university-affiliated pediatric emergency department embedded within a major regional trauma center in Turkey. Patients aged 1 to 18 years with firearm injuries were tracked between January 1, 2021, and May 30, 2024. Trauma scores were calculated for each patient from baseline admission data.
Results:
Among 353 patients (81.6% male; mean age: 13.9±3.8 y), overall mortality was 5.4% (n=19). The RTS exhibited superior mortality prediction (AUC: 0.991, 95% CI: 0.987-0.995; cutoff <5.26), followed by PTS (AUC: 0.988), Injury Severity Score (AUC: 0.969), PBIG score (n=135, AUC: 0.957, cutoff >16.35), and Glasgow Coma Scale (GCS; AUC: 0.938) (all P <0.001). In multivariable regression, the RTS emerged as the sole independent predictor of in-hospital mortality (adjusted OR=0.125, 95% CI: 0.039-0.402; P <0.001), while GCS and ISS lost independent significance.
Conclusion:
Multivariable modeling identifies the RTS as the sole independent predictor of mortality, whereas the ISS provides optimal accuracy for predicting intensive care admission. Integrating these laboratory-independent scores into automated electronic health record alerts can standardize secondary risk stratification and expedite resource allocation in pediatric firearm trauma.
