Date of Award

January 2014

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Kirsten Bechtel

Subject Area(s)

Medicine

Abstract

Trauma is the leading cause of pediatric mortality and morbidity in the United States, but there is no widely accepted trauma scoring criteria for the rapid triage of acute injuries in children. The objective of this study was to evaluate the association of the Pediatric Trauma Score (PTS) with central nervous system injury (CNS) and solid organ injury (SOI), subspecialist operative management, and emergency department (ED) disposition in pediatric trauma patients. Our hypothesis was that PTS would be adequately assosciated with these outcomes. We performed a retrospective review of the medical records of all patients less than 16 years of age evaluated for acute injuries in our Level I Pediatric Trauma Center from 1/2005-12/2011, excluding patients transferred from referring hospitals. Demographics, PTS criteria, and outcomes were abstracted. Receiver Operating Curve characteristics were performed to determine the predictive ability (AUC-Area under the Curve) of the PTS at detecting outcomes. Our results included 3,817 patients, the average age was 7.25 years; 66.1% were male; and 98.4% sustained blunt trauma. Mean PTS value was 10.0. PTS had an outstanding association with mortality (AUC: 0.996; SE: 0.001). PTS had an acceptable association with CNS injury (AUC: 0.750; SE: 0.029) and operative management including neurosurgery (AUC: 0.788; SE: 0.041), reconstructive surgery (AUC: 0.750; SE: 0.051), and pediatric surgery (AUC: 0.746; SE: 0.027). PTS had a poor association with solid organ injury (AUC: 0.572, SE: 0.038); operative management by orthopedic surgery (AUC: 0.565, SE: 0.014); and ED disposition including discharge to home (AUC: 0.641, SE: 0.009), admission to the intensive care unit (AUC: 0.689, SE: 0.017), and admission to the surgical ward (AUC: 0.667, SE: 0.018). In conclusion, PTS may be a useful means to triage acute injury in children and to predict likelihood of mortality, presence of CNS injury, and need for subspecialist surgical management.

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This is an Open Access Thesis.

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