Initial Stabilization and Trauma Scoring Systems in Pediatric Multiple Trauma

Özlem TOLU KENDİRa , Oğuz DURSUNb

aAkdeniz University Faculty of Medicine, Department of Pediatric Emergency Medicine, Antalya, Türkiye
bAkdeniz University Faculty of Medicine, Department of Pediatric Intensive Care, Antalya, Türkiye

ABSTRACT
The most important cause of early death in paediatric trauma is inadequate patient assessment and management. There is no universally accepted triage score for paediatric trauma. Each of the existing systems has strengths and weaknesses arising from its components. It has been shown that prehospital triage scores can influence the type of transport and reduce mortality. Although blunt trauma is more common in children, they are more prone to multi-system involvement. Therefore, the team responsible for paediatric trauma patients should be prepared to rapidly recognise and manage serious and life-threatening situations. They should have age-appropriate resuscitation equipment available and be experienced in administering life-saving treatments. The first objectives in the management of trauma patients are rapid assessment of injuries, setting priorities and performing critical interventions. Rapid primary survey includes resuscitation of vital functions such as airway, breathing and circulation. At this stage, diagnostic evaluations and treatment are carried out simultaneously. This is followed by secondary survey and completion of necessary additional interventions. In case of any clinical deterioration, the primary survey should be repeated immediately.
Keywords: Cumulative trauma disorders; triage; injury severity score; airway management; child abuse

Referanslar

  1. Fallat ME, Treager C, Humphrey S, et al., A Novel Approach to Assessment of US Pediatric Trauma System Development. JAMA Surgery. 2022;157(11):1042-9. [Crossref]  [PubMed]  [PMC]
  2. Olguner M, Duman M. Çoğul travmalı hastaya yaklaşım. Karaböcüoğlu M, Yılmaz HL, Duman M, editörler. Çocuk Acil Tıp Kapsamlı ve Kolay Yaklaşım. 1. Baskı. İstanbul: İstanbul Tıp Kitabevi; 2012. p.2295-300.
  3. Borgialli DA, Mahajan P, Hoyle JD, et al. Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma. Academic Emergency Medicine. 2016;23(8):878-84. [Crossref]  [PubMed]
  4. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989;29(5):623-9. [Crossref]  [PubMed]
  5. Furnival RA, Schunk JE. ABCs of scoring systems for pediatric trauma. Pediatr Emerg Care. 1999;15(3):215-23. [Crossref]  [PubMed]
  6. Jeong YS, Shah S, Akula S, Novotny N, Menoch M. Pediatric trauma smackdown: PTS vs SIPA. Injury. 2023;54(5):1297-301. [Crossref]  [PubMed]
  7. Baker SP, O'Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187-96. [Crossref]  [PubMed]
  8. Schluter PJ, Nathens A, Neal ML, et al. Trauma and Injury Severity Score (TRISS) coefficients 2009 revision. J Trauma. 2010;68(4):761-70. [Crossref]  [PubMed]
  9. Schall LC, Potoka DA, Ford HR. A new method for estimating probability of survival in pediatric patients using revised TRISS methodology based on age-adjusted weights. J Trauma. 2002:52(2):235-41. [Crossref]  [PubMed]
  10. Champion HR, Copes WS, Scco WJ, et al., A new characterization of injury severity. J Trauma. 1990;30(5):539-45. [Crossref]  [PubMed]
  11. Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med. 1996;24(5):743-52. [Crossref]  [PubMed]
  12. Straney L, Clements A, Parslow C, et al. Paediatric index of mortality 3: an updated model for predicting mortality in pediatric intensive care. Pediatr Crit Care Med. 2013;14(7):673-81. [Crossref]  [PubMed]
  13. Borgman MA, Maegele M, Wade CE, Blackbourne LH, Spinella PC. Pediatric trauma BIG score: predicting mortality in children after military and civilian trauma. Pediatrics. 2011;127(4):e892-7. [Crossref]  [PubMed]
  14. Kıhtır HS, Ongun EA. BIG score is a strong predictor of mortality and morbidity for high-energy traumas in pediatric intensive care unit. Ulus Travma Acil Cerrahi Derg. 2022;28(9):1292-7. [Crossref]  [PubMed]  [PMC]
  15. Mora MC, Veras L, Burke RV, et al. Pediatric trauma triage: A Pediatric Trauma Society Research Committee systematic review. J Trauma Acute Care Surg. 2020;89(4):623-30. [Crossref]  [PubMed]
  16. Fylli C, Schipper IB, Krijnen P. Pediatric Trauma in The Netherlands: Incidence, Mechanism of Injury and In-Hospital Mortality. World Journal of Surgery. 2023;47(5):1116-28. [Crossref]  [PubMed]  [PMC]
  17. Kennedy AP, Scorpio RJ, Coppola CP. Assessment of the pediatric trauma patient: differences in approach. J. Emerg.Crit Care Med. 2018;2(1):4-4. [Crossref]
  18. Lee LK, Farrell C. Trauma management: Approach to the unstable child. UpToDate. (cited 22, 2023). Available from: [Link]
  19. Elkbuli A, Zajd S, Ehrhardt JD, McKenney M, Boneva D. Aggressive Crystalloid Resuscitation Outcomes in Low-Severity Pediatric Trauma. J Surg Res. 2020;247:350-5. [Crossref]  [PubMed]
  20. Baird JS, Cooper A. Multiple Trauma. In: Nichols DG, Shaffner DH. Roger's Textbook of Pediatric Intensive Care. 5th ed. China: Wolters Kluwer; 2016. p. 417-27.
  21. Anand T, Obaid O, Nelson A, et al., Whole blood hemostatic resuscitation in pediatric trauma: A nationwide propensity-matched analysis. J Trauma Acute Care Surg. 2021;91(4):573-8. [Crossref]  [PubMed]
  22. Newman B, Callahan MJ. ALARA (as low as reasonably achievable) CT 2011--executive summary. Pediatr Radiol. 2011;41(Suppl 2):453-5. [Crossref]  [PubMed]
  23. Notrica DM, Eubanks JW, Tuggle DW, et al. Nonoperative management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg. 2015;79(4):683-93. [Crossref]  [PubMed]
  24. Hubbard EW, Riccio AI. Pediatric Orthopedic Trauma: An Evidence-Based Approach. Orthop Clin North Am. 2018;49(2):195-210. [Crossref]  [PubMed]