St-Louis Etienne, Séguin Jade, Roizblatt Daniel, Deckelbaum Dan Leon, Baird Robert, Razek Tarek
Centre for Global Surgery, McGill University Health Centre, Montreal, QC, Canada.
Division of Pediatric Emergency Medicine, McGill University Health Centre, Montreal, QC, Canada.
Pediatr Surg Int. 2017 Mar;33(3):299-309. doi: 10.1007/s00383-016-4024-9. Epub 2016 Nov 21.
Trauma is a leading cause of mortality and disability in children worldwide. The World Health Organization reports that 95% of all childhood injury deaths occur in Low-Middle-Income Countries (LMIC). Injury scores have been developed to facilitate risk stratification, clinical decision making, and research. Trauma registries in LMIC depend on adapted trauma scores that do not rely on investigations that require unavailable material or human resources. We sought to review and assess the existing trauma scores used in pediatric patients. Our objective is to determine their wideness of use, validity, setting of use, outcome measures, and criticisms. We believe that there is a need for an adapted trauma score developed specifically for pediatric patients in low-resource settings.
A systematic review of the literature was conducted to identify and compare existing injury scores used in pediatric patients. We constructed a search strategy in collaboration with a senior hospital librarian. Multiple databases were searched, including Embase, Medline, and the Cochrane Central Register of Controlled Trials. Articles were selected based on predefined inclusion criteria by two reviewers and underwent qualitative analysis.
The scores identified are suboptimal for use in pediatric patients in low-resource settings due to various factors, including reliance on precise anatomic diagnosis, physiologic parameters maladapted to pediatric patients, or laboratory data with inconsistent accessibility in LMIC.
An important gap exists in our ability to simply and reliably estimate injury severity in pediatric patients and predict their associated probability of outcomes in settings, where resources are limited. An ideal score should be easy to calculate using point-of-care data that are readily available in LMIC, and can be easily adapted to the specific physiologic variations of different age groups.
创伤是全球儿童死亡和残疾的主要原因。世界卫生组织报告称，所有儿童伤害死亡中有95%发生在低收入和中等收入国家（LMIC）。损伤评分已被开发出来，以促进风险分层、临床决策和研究。LMIC的创伤登记依赖于经过调整的创伤评分，这些评分不依赖于需要无法获得的材料或人力资源的检查。我们试图回顾和评估儿科患者中使用的现有创伤评分。我们的目标是确定它们的使用范围、有效性、使用场景、结局指标和批评意见。我们认为，需要专门为资源匮乏环境中的儿科患者开发一种经过调整的创伤评分。
对文献进行系统回顾，以识别和比较儿科患者中使用的现有损伤评分。我们与一位资深医院图书馆员合作构建了搜索策略。搜索了多个数据库，包括Embase、Medline和Cochrane对照试验中央注册库。文章由两位审稿人根据预先定义的纳入标准进行选择，并进行定性分析。
由于各种因素，包括依赖精确的解剖诊断、不适用于儿科患者的生理参数或LMIC中获取不一致的实验室数据，所确定的评分在资源匮乏环境中的儿科患者中使用并不理想。
在资源有限的环境中，我们在简单可靠地估计儿科患者的损伤严重程度并预测其相关结局概率方面存在重大差距。理想的评分应该使用LMIC中随时可用的即时护理数据易于计算，并且可以轻松适应不同年龄组的特定生理变化。
