Academic Emergency Medicine
Background and Objectives: Different scoring tools have been established to aid in prediction of pediatric trauma patients recovering and survival but not one is used consistently. Pediatric Trauma Score (PTS) is one of the first tools developed & evaluates pediatric trauma rapidly in a comprehensive manner using 6 determinants to help predict outcomes. Shock Index Pediatric Adjusted (SIPA) adapts shock index (SI) in predicting outcomes for trauma patients adjusted to the pediatric population. It is unclear which scoring tool is best at predicting outcomes. SIPA is easier to calculate & will be more convenient to use in the ED or pre-hospital setting. Methods: This is a single center retrospective electronic chart review study of patients 1- 17 years with level I & II activated trauma between 1/2013 – 11/2019. Outcomes of interest were hospital admission, ICU admission, ICU & hospital LOS and complications of ventilator use, major liver or spleen lacerations, blood product use, high ISS (> 15) and fluid bolus use. Patient visits were scored for both SIPA and PTS, then placed into either high risk and low risk category as predefined by the individual scoring tools: High risk SIPA (elevated SI for age), low risk SIPA (normal SI for age), high risk PTS (scores: −6 to 8), low risk PTS (scores: > 8). Results: Of 1667 patients, 757 met inclusion. The predominant scores for each tool were low risk. See table 1 for demographics and scoring details. When the scoring systems were compared, there were 36 visits that scored high in both systems and 542 visits that scored low in both systems. A comparison of high-risk scores to low risk scores for both tools, findings suggesting an increased odds ratio (OR) for all outcomes for each scoring tool’s high risk group in comparison to its low risk group with the exception of fluid bolus use for PTS. When both high risk groups were compared, PTS had an increased OR for outcomes such as hospital & ICU admission, ventilator use, blood product use, fluid bolus use (p < 0.05) & major spleen or liver laceration (p = 0.16). SIPA had an increased OR for high ISS (p = 0.14). Conclusion: Both PTS & SIPA seem to be reliable predictors of outcomes for level 1 & II trauma activated pediatric patients, but PTS catches more “high risk” visits. However, is more tedious to calculate than SIPA. Given reliability of SIPA as an outcome predictor, this may be a fast & effective way to triage pediatric trauma patients.
Jeong YS, Shah S, Akula S, Novotny NM, Menoch M. Shock index pediatric adjusted score vs pediatric trauma score in the emergency department: so many scores, so little time. Acad Emerg Med. 2021 May;28(Suppl 1):S338-339.