Development of a Novel age-specific pediatric trauma score

Abstract

Trauma scoring systems are needed to provide efficient triage of injured patients and to assess differences in outcomes and quality of care between different trauma centers. Current scoring systems used in pediatric trauma are not age specific, and thus have significant limitations. The authors queried the Pennsylvania Trauma Outcome Study for all children 0 to 16 years entered in the database from 1993 to 1996. Age-specific threshold values for systolic blood pressure, pulse, and respiratory rate were established. Using coded scores for these age-specific values and Glasgow Coma Scale, an age-specific pediatric trauma score (ASPTS) was derived. Triage ASPTS (T-ASPTS) consisted of the integer sum of coded scores for the 4 variables, whereas ASPTS was calculated using weighted coefficients derived from logistic regression for each variable. T-ASPTS correlated with mortality rate. Using a threshold score of less than 10, T-ASPTS predicted mortality rate with a sensitivity of 96.97% and a specificity of 88.83%. T-ASPTS predicted mortality rate and percentage of patients with Injury Severity Score greater than 20 with similar sensitivity to the Revised Trauma Score (RTS), but T-ASPTS was more specific. The ASPTS predicted probability of survival more accurately than the RTS. ASPTS performs favorably as both a triage score and as a tool for predicting probability of survival for outcomes analysis. Further comparisons to existing trauma scores are needed to verify the utility of ASPTS.