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    Pediatric Trauma Score (PTS)

    Stratifies severity of traumatic injury in children.
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    INSTRUCTIONS

    Use in pediatric patients (age <18 years) presenting with trauma. Poorly validated in blunt abdominal trauma.

    When to Use
    Pearls/Pitfalls
    Why Use

    • Pediatric patients (age <18 years) presenting with trauma.

    • Use with caution in patients with blunt abdominal trauma, as the score is poorly validated in this population.

    • Should not be used to predict isolated injuries.

    • Best used as a general predictor of stratifying injury severity.

    • Poorly validated in blunt abdominal trauma, specifically to predict isolated injuries such as liver and spleen (Saladino 1991).

    • Helps providers stratify risk of significant injury with high mortality risk.

    • Helps triage patients in a resource-limited environment by identifying children with high mortality risk compared to patients who may not be as critically ill and require fewer resources.

    • May also be used by first responders on scene to help triage patients requiring transfer to a pediatric trauma center vs transfer to a facility that has pediatric providers who can help to provide initial care to trauma patients.

    >20 kg (>44 lbs)
    +2
    10-20 kg (22-44 lbs)
    +1
    <10 kg (<22 lbs)
    -1
    Normal
    +2
    Maintainable
    +1
    Unmaintainable
    -1
    >90 mmHg (or pulse palpable at wrist)
    +2
    50-90 mmHg (or pulse palpable at groin)
    +1
    <50 mmHg (or no pulse palpable)
    -1
    Awake
    +2
    Obtunded/loss of consciousness
    +1
    Coma/decerebrate
    -1
    None
    +2
    Closed fracture
    +1
    Open/multiple fractures
    -1
    None
    +2
    Minor
    +1
    Major/penetrating
    -1

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Advice

    • Patient conditions may change after initial assessment and scoring.

    • Patients should continue to be monitored for evolution of signs and symptoms.

    • Should not be used to advise patients that medical attention is not needed after trauma, as a full evaluation by a medical provider is still recommended.

    Management

    • After scoring is completed, high risk patients (i.e., low scores) should be triaged for immediate medical attention at a pediatric trauma center if one is nearby, or stabilization at the closest medical facility at the discretion of the first responder.

    • Patients with higher scores are less likely to have significant morbidity and mortality, but require reassessment as symptoms evolve. Evaluation by a physician including a complete history and physical is still recommended.  

    Critical Actions

    Do not forget that reassessment is an essential part of patient care in all interactions. Patients with an initial score indicating morbidity and mortality may have changes in clinical status, and recalculation may be necessary.

    Formula

    Addition of the selected points:

    Variable

    Points

    Weight

    >20 kg (>44 lbs)

    2

    10-20 kg (22-44 lbs)

    1

    <10 kg (<22 lbs)

    -1

    Airway status

    Normal

    2

    Maintainable

    1

    Unmaintainable

    -1

    Systolic BP*

    >90 mmHg

    2

    50-90 mmHg

    1

    <50 mmHg

    -1

    Central nervous system

    Awake

    2

    Obtunded/loss of consciousness

    1

    Coma/decerebrate

    -1

    Skeletal injury

    None

    2

    Closed fracture

    1

    Open/multiple fractures

    -1

    Cutaneous wounds

    None

    2

    Minor

    1

    Major/penetrating

    -1

    *If proper-sized BP cuff not available, BP can be assessed by assigning points as follows:

    Pulse palpable at wrist

    2

    Pulse palpable at groin

    1

    No pulse palpable

    -1

    Facts & Figures

    Interpretation:

    Higher scores correlate with lower mortality (total scores range from -6 to 12 points). In the original and validation studies, no deaths were seen in patients with scores >8.

    Evidence Appraisal

    The PTS was first described by Tepas et al (1987) in a matched cohort study comparing two groups of 110 and 120 pediatric trauma patients, respectively, and found a linear relationship between the PTS and the Injury Severity Score (ISS). They further validated their findings in a retrospective cohort study that included data for 615 children entered into the National Pediatric Trauma Registry between April and December 1985 (Tepas 1988).

    This study confirmed the correlation between increasing PTS and increasing ISS. Notably, the study authors did not correlate the findings with mechanism of injury. The study found that a PTS <0 had a 100% mortality rate and a PTS >8 was associated with no mortality; patients with PTS 0-8 had decreasing mortality rates as the PTS increased, showing an inverse linear correlation between increasing severity of injury and decreasing PTS. 

    Ramenofsky et al (1988) further validated these findings in a cohort of 450 injured children evaluated by a paramedic in the field and a physician in the ED (Tepas 1988). They confirmed linear correlation of PTS with injury severity and found 93.6% correlation between the two providers (correlation coefficient 0.991).

    A later study found that PTS poorly predicted isolated blunt abdominal injuries (liver and spleen) (Saladino 1991).

    Dr. Joseph J. Tepas

    About the Creator

    Joseph J. Tepas, MD, FACS, is an emeritus professor in the department of surgery at University of Florida (UF) College of Medicine in Gainesville, Florida. He is also the chief of the division of pediatric surgery at UF Health. Dr. Tepas’ primary research is focused on pediatric trauma and congenital anomalies.

    To view Dr. Joseph J. Tepas's publications, visit PubMed

    Content Contributors
    • Matthew Lecuyer, MD
    About the Creator
    Dr. Joseph J. Tepas
    Content Contributors
    • Matthew Lecuyer, MD