Bibiana Dello Russo
As trauma is the leading cause of mortality in pati ents under the age of 35 years optimizing both pre- hospital and initial in-hospital care is of utmost importance . Many different scores have been proposed. The aim of the present retrospective study was to c ompare the predictive value of two pediatric trauma scores: the pediatric trauma score (PTS) and the mo dified injury severity scale (MISS). The study population consisted of 84 patients (64 boys and 20 girls) admitted to the intensive care unit of the Garrahan Hospital between November 11, 1987 and Aug ust 1, 1991 with a diagnosis of polytrauma. For each score the level of severity of injury of the c hildren in the study population was determined. The predictive abilities of the scores were analyzed as to final outcome (survival-death), sensitivity, specificity, and positive and negative predictive v alue of the PTS with a cut-off point of 3 or less a nd of the MISS with a cut-off point of 25 or more. PTS wi th a cut-off point of 3 or less had both a high specificity and a high predictive value accurately discriminating the cases with a low risk of mortali ty (94%). The positive predictive value was somewhat l ess, but still satisfactory for the detection of th e patients with a high risk of mortality (66%). With a cut-off point of 25 or more, the predictive accur acy of the MISS was similar to that of the PTS with a slig htly higher sensitivity (83%) and specificity (78%) However, the positive predictive value was low (38. 5%) and the negative predictive value was 96.7%. In conclusion, in the pre-hospital stage on the site o f the accident and during the initial care at the h ospital the PTS demonstrates to be a very useful tool to as sess injury severity of the patient, to decide on t he first treatment measures, and to evaluate the degre e of complexity of care the patient needs.
Share this article