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Injury severity score as a guide to nutritional management of the pediatric trauma patient
S Tormoen1, R W Powell, A Luterman
1Department of Surgery, University of South Alabama College of Medicine, Mobile, USA.
Insights
Estimating nutritional needs for injured children is complex. This study found that children with milder injuries require more calories than recommended dietary allowances, while severely injured children need less.
Area of Science:
- Pediatric critical care
- Nutritional science
- Trauma management
Background:
- Pediatric trauma patients have complex nutritional needs due to age, injury severity, metabolic rate, and growth.
- Accurate estimation of energy requirements is crucial for optimal recovery.
Purpose of the Study:
- To determine the energy requirements of pediatric trauma patients in relation to injury severity.
- To compare theoretical caloric requirements with established dietary recommendations.
Main Methods:
- Retrospective analysis of 14 pediatric trauma patients over a 5-year period with significant weight loss and caloric deficit.
- Calculation of Theoretical Caloric Requirement (ThCR) based on actual weight loss and caloric intake.
- Comparison of ThCR with 1989 Recommended Dietary Allowances (RDA) and injury severity scores (ISS, PTS, TSS).
Main Results:
- 86% of ThCR were less than or equal to the 1989 RDA.
- The per cent increase of ThCR above basal metabolic rate was significantly higher for lower Injury Severity Scores (ISS).
- Mildly injured children required 1.8% more calories than RDA, while severely injured children (ISS > 25) required 26.5% fewer calories than RDA.
Conclusions:
- Nutritional requirements vary significantly with injury severity in pediatric trauma.
- For milder injuries, caloric requirements should be based on RDA.
- For severe injuries (ISS > 25), a modified approach using 0.75 RDA is recommended.
Abstract:
Age, degree of injury, different metabolic rates, and growth complicate the estimation of nutritional requirements in the pediatric trauma victim. This study was designed to determine energy requirements of the injured child in relation to injury severity. Fourteen patients of 600 seen in a 5-year period met our criteria for evaluation with significant weight loss, caloric deficit recorded to the lowest weight, and details of injury. There were 10 males and four females with a mean age of 11.24 years (+/- 5.5). Mean injury scores included ISS 24.24 +/- 5.96, PTS 4.8 +/- 1.7, and TSS 11.79 +/- 2.78. The closest Theoretical Caloric Requirement (ThCR) that would have produced the Cumulative Caloric Deficit was calculated from the actual weight loss and Caloric Intake. Eighty-six per cent of the ThCR were less than or equal to the 1989 Recommended Dietary Allowances (RDA) (mean -16.43 +/- 24%). The per cent increase of the ThCR above the basal was significantly higher for lower ISS scores (P < 0.05). When compared to RDA, the per cent change of the ThCR for mild injuries were 1.8 +/- 27.9% above the RDA and were 26.5 +/- 17.2% below the RDA for the severe injuries. These findings are consistent with the child with milder injuries resuming activity and the growth process earlier than a severely injured child. We would recommend calculating caloric requirements based on the RDA for milder injuries and on 0.75 RDA for the more severely injured child (ISS > 25).