Jeong Yae Sul, Shah Sagar, Akula Saketh, Novotny Nathan, Menoch Margaret
Department of Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, OH, United States.
Department of Emergency Medicine, Memorial Belleville Hospital, Memorial Shiloh Hospital, IL, United States.
Injury. 2023 May;54(5):1297-1301. doi: 10.1016/j.injury.2023.02.045. Epub 2023 Mar 2.
Different scoring tools aid prediction of pediatric trauma patients' prognosis but there's no consensus on when to apply each. Pediatric Trauma Score (PTS) was one of the first tools developed. Shock Index Pediatric Adjusted (SIPA) adapts Shock Index (SI) in predicting outcomes adjusted for age. It is unclear if either scoring tool is better at predicting outcomes.
To compare SIPA and PTS for level I and II pediatric traumas to determine if both are equally effective in predicting outcomes for pediatric trauma patients.
DESIGN/METHODS: This is a retrospective review of patients 1-17 years with level 1 and 2 activated trauma (1/2013 - 11/2019).
disposition, length of stay, ventilator use, moderate/major spleen/liver lacerations, and Index Severity Score (ISS). Patient visits were scored using both scores and placed into high/low risk category as predefined by the individual scoring tools: High risk SIPA, low risk SIPA, high risk PTS, low risk PTS.
There were 750 patients who met inclusion criteria, 35 visits scored high with both tools and 543 visits scored low. The odds ratio (OR) for each tool showed high risk scores were more likely to be associated with increased likelihood of outcomes. When both high-risk groups were compared, PTS had an increased OR for most outcomes. SIPA had an increased OR for receiving fluid bolus.
This study externally validates both scoring tools for the same cohort. Both tools were reliable predictors, but PTS identifies more "high risk" visits. PTS requires more variables to calculate than SIPA. SIPA may be an effective way to triage when resources are scarce. However, there's still a need for a pediatric trauma triage score that can encompass the accuracy of PTS and the convenience of SIPA.
不同的评分工具有助于预测儿科创伤患者的预后，但对于何时应用每种工具尚无共识。儿科创伤评分（PTS）是最早开发的工具之一。小儿调整休克指数（SIPA）在预测经年龄调整的结果时采用了休克指数（SI）。目前尚不清楚这两种评分工具在预测结果方面是否有更好的表现。
比较SIPA和PTS在I级和II级儿科创伤中的应用，以确定两者在预测儿科创伤患者的结果方面是否同样有效。
设计/方法：这是一项对1 - 17岁I级和II级激活创伤患者（2013年1月 - 2019年11月）的回顾性研究。
处置方式、住院时间、呼吸机使用情况、中度/重度脾/肝裂伤以及损伤严重度评分（ISS）。使用两种评分对患者就诊情况进行评分，并按照各评分工具预先定义的标准分为高/低风险类别：高风险SIPA、低风险SIPA、高风险PTS、低风险PTS。
有750名患者符合纳入标准，35次就诊在两种工具下均评分为高，543次就诊评分为低。每种工具的优势比（OR）显示，高风险评分更有可能与结果增加的可能性相关。当比较两个高风险组时，PTS在大多数结果方面的OR更高。SIPA在接受液体冲击方面的OR更高。
本研究在同一队列中对两种评分工具进行了外部验证。两种工具都是可靠的预测指标，但PTS识别出更多“高风险”就诊情况。PTS比SIPA需要更多变量来计算。在资源稀缺时，SIPA可能是一种有效的分诊方法。然而，仍然需要一种能够兼顾PTS的准确性和SIPA的便利性的儿科创伤分诊评分。
