Classification of trauma in children
- Tom Brazelton, MD, MPH, FAAP
Tom Brazelton, MD, MPH, FAAP
- Associate Professor of Pediatrics
- University of Wisconsin School of Medicine and Public Health
- Ankush Gosain, MD, PhD, FACS, FAAP
Ankush Gosain, MD, PhD, FACS, FAAP
- Associate Professor of Surgery and Pediatrics
- Children's Foundation Research Institute
- Le Bonheur Children's Hospital
- University of Tennessee Health Sciences Center
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will discuss the classification of pediatric trauma. The initial management of trauma in stable and unstable children is discussed separately. (See "Trauma management: Approach to the unstable child" and "Approach to the initially stable child with blunt or penetrating injury".)
Injuries are the leading cause of death for children and adolescents in the United States (table 1) and most high-income countries . Deaths from unintentional injuries account for more years of potential life lost before age 65 years than cancer, heart disease, or any other cause of death . For every injury death, an estimated 25 hospitalizations and 925 emergency department visits occur. Most of these injuries are caused by falls, motor vehicle collisions (MVCs), bicycle collisions, and burns; many are preventable. (See "Pediatric injury prevention: Epidemiology, history, and application" and "Prevention of falls in children".)
Due in large part to national injury prevention efforts, the overall unintentional injury death rate in United States children, aged 0 to 19 years, declined by 29 percent from 2000 to 2009. These injury prevention efforts include seat belt use, child safety seat and booster seat use, licensing requirements, vehicle design, and reductions in alcohol-impaired driving. (See "Pediatric injury prevention: Epidemiology, history, and application", section on 'Epidemiology'.)
However, even with these efforts, MVCs remain the leading cause of unintentional injury death among 15 to 19 year olds. Furthermore, the unintentional injury death rate for infants younger than one year of age has risen from 2000 to 2009. It is clear that ongoing injury prevention efforts, such as the National Action Plan for Child Injury Prevention , are needed to prevent these needless injuries and deaths. (See "Pediatric injury prevention: Epidemiology, history, and application", section on 'Injury prevention resources'.)
Types of prevention include:
- Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health 2000; 90:523.
- CDC. Web-based Injury Statistics Query and Reporting Ssytem (WISQARS). Atlanta, GA: US Department of Health and Human Services, CDC; 2009. http://www.cdc.gov/injury/wisqars/index.html (Accessed on August 13, 2013).
- Baldwin G, Sleet D, Gilchrist J, Degutis L. Fulfilling a promise: the national action plan for child injury prevention. Inj Prev 2012; 18:207.
- Engum SA, Mitchell MK, Scherer LR, et al. Prehospital triage in the injured pediatric patient. J Pediatr Surg 2000; 35:82.
- Sasser SM, Hunt RC, Sullivent EE, et al. Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage. MMWR Recomm Rep 2009; 58:1.
- Tepas JJ 3rd, Ramenofsky ML, Barlow B, et al. National Pediatric Trauma Registry. J Pediatr Surg 1989; 24:156.
- Champion HR, Copes WS, Sacco WJ, et al. The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma 1990; 30:1356.
- Marcin JP, Pollack MM. Triage scoring systems, severity of illness measures, and mortality prediction models in pediatric trauma. Crit Care Med 2002; 30:S457.
- Ruddy RM, Fleisher GR. An approach to the injured child. In: Textbook of Pediatric Emergency Medicine, 5th, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1339.
- Furnival RA, Schunk JE. ABCs of scoring systems for pediatric trauma. Pediatr Emerg Care 1999; 15:215.
- Eichelberger MR, Gotschall CS, Sacco WJ, et al. A comparison of the trauma score, the revised trauma score, and the pediatric trauma score. Ann Emerg Med 1989; 18:1053.
- Tepas JJ 3rd, Ramenofsky ML, Mollitt DL, et al. The Pediatric Trauma Score as a predictor of injury severity: an objective assessment. J Trauma 1988; 28:425.
- Aprahamian C, Cattey RP, Walker AP, et al. Pediatric Trauma Score. Predictor of hospital resource use? Arch Surg 1990; 125:1128.
- Beskind DL, Keim SM, Spaite DW, et al. Risk adjustment measures and outcome measures for prehospital trauma research: recommendations from the emergency medical services outcomes project (EMSOP). Acad Emerg Med 2011; 18:988.
- Bruce, DA, Raphaely, RC, Goldbert, AI, et al. Pathophysiology, treatment and outcome following severe head injury in children. Child's Brain 1979; 5:175.
- Young B, Rapp RP, Norton JA, et al. Early prediction of outcome in head-injured patients. J Neurosurg 1981; 54:300.
- Hannan EL, Farrell LS, Meaker PS, Cooper A. Predicting inpatient mortality for pediatric trauma patients with blunt injuries: a better alternative. J Pediatr Surg 2000; 35:155.
- Ross SE, Leipold C, Terregino C, O'Malley KF. Efficacy of the motor component of the Glasgow Coma Scale in trauma triage. J Trauma 1998; 45:42.
- Acker SN, Ross JT, Partrick DA, et al. Glasgow motor scale alone is equivalent to Glasgow Coma Scale at identifying children at risk for serious traumatic brain injury. J Trauma Acute Care Surg 2014; 77:304.
- Borgialli DA, Mahajan P, Hoyle JD Jr, et al. Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma. Acad Emerg Med 2016; 23:878.
- Chou R, Totten AM, Pappas M, et al. Glasgow Coma Scale for Field Triage of Trauma: A Systematic Review. Comparative Effectiveness Review No. 182. AHRQ Publication No. 16(17)-EHC041-EF. Rockville MD: Agency for Healthcare Research and Quality. January 2017. www.effective healthcare.ahrq.gov/reports/final.cfm
- Champion HR, Sacco WJ, Copes WS, et al. A revision of the Trauma Score. J Trauma 1989; 29:623.
- Kaufmann CR, Maier RV, Rivara FP, Carrico CJ. Evaluation of the Pediatric Trauma Score. JAMA 1990; 263:69.
- Saladino R, Lund D, Fleisher G. The spectrum of liver and spleen injuries in children: failure of the pediatric trauma score and clinical signs to predict isolated injuries. Ann Emerg Med 1991; 20:636.
- Potoka DA, Schall LC, Ford HR. Development of a novel age-specific pediatric trauma score. J Pediatr Surg 2001; 36:106.
- Rating the severity of tissue damage. I. The abbreviated scale. JAMA 1971; 215:277.
- Baker SP, O'Neill B. The injury severity score: an update. J Trauma 1976; 16:882.
- Injury severity score. www.trauma.org/archive/scores/iss.html (Accessed on August 21, 2013).
- Copes WS, Champion HR, Sacco WJ, et al. The Injury Severity Score revisited. J Trauma 1988; 28:69.
- Karmy-Jones R, Copes WS, Champion HR, et al. Results of a multi-institutional outcome assessment: results of a structured peer review of TRISS-designated unexpected outcomes. J Trauma 1992; 32:196.
- Brown JB, Gestring ML, Leeper CM, et al. The value of the injury severity score in pediatric trauma: Time for a new definition of severe injury? J Trauma Acute Care Surg 2017; 82:995.
- Haider AH, Crompton JG, Oyetunji T, et al. Mechanism of injury predicts case fatality and functional outcomes in pediatric trauma patients: the case for its use in trauma outcomes studies. J Pediatr Surg 2011; 46:1557.
- Trauma-injury severity score. www.trauma.org/index.php/main/article/387/ (Accessed on August 21, 2013).
- Schluter PJ, Nathens A, Neal ML, et al. Trauma and Injury Severity Score (TRISS) coefficients 2009 revision. J Trauma 2010; 68:761.
- 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; 52:235.
- Champion HR, Copes WS, Sacco WJ, et al. A new characterization of injury severity. J Trauma 1990; 30:539.
- Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 1996; 24:743.
- Castello FV, Cassano A, Gregory P, Hammond J. The Pediatric Risk of Mortality (PRISM) Score and Injury Severity Score (ISS) for predicting resource utilization and outcome of intensive care in pediatric trauma. Crit Care Med 1999; 27:985.
- Straney L, Clements A, Parslow RC, et al. Paediatric index of mortality 3: an updated model for predicting mortality in pediatric intensive care*. Pediatr Crit Care Med 2013; 14:673.
- Wolfler A, Osello R, Gualino J, et al. The Importance of Mortality Risk Assessment: Validation of the Pediatric Index of Mortality 3 Score. Pediatr Crit Care Med 2016; 17:251.
- Slater A, Shann F, Pearson G, Paediatric Index of Mortality (PIM) Study Group. PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med 2003; 29:278.
- Brady AR, Harrison D, Black S, et al. Assessment and optimization of mortality prediction tools for admissions to pediatric intensive care in the United kingdom. Pediatrics 2006; 117:e733.
- Rutledge R, Osler T, Emery S, Kromhout-Schiro S. The end of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, ninth revision-based prediction tool, outperforms both ISS and TRISS as predictors of trauma patient survival, hospital charges, and hospital length of stay. J Trauma 1998; 44:41.
- Tepas JJ 3rd, Leaphart CL, Celso BG, et al. Risk stratification simplified: the worst injury predicts mortality for the injured children. J Trauma 2008; 65:1258.
- Allen CJ, Wagenaar AE, Horkan DB, et al. Predictors of mortality in pediatric trauma: experiences of a level 1 trauma center and an assessment of the International Classification Injury Severity Score (ICISS). Pediatr Surg Int 2016; 32:657.
- Borgman MA, Maegele M, Wade CE, et al. Pediatric trauma BIG score: predicting mortality in children after military and civilian trauma. Pediatrics 2011; 127:e892.
- Davis AL, Wales PW, Malik T, et al. The BIG Score and Prediction of Mortality in Pediatric Blunt Trauma. J Pediatr 2015; 167:593.
- Borgman MA, Spinella PC. What is the Big Deal about the BIG Score? J Pediatr 2015; 167:513.
- INJURY PREVENTION
- CLASSIFICATION OF TRAUMA
- - Triage decision support
- - Severity of illness or mortality prediction
- Physiologic systems
- - Glasgow Coma Scale
- - Trauma Score
- - Revised Trauma Score
- - Pediatric Trauma Score
- - Age-specific pediatric trauma score
- Anatomic systems
- - Abbreviated Injury Scale
- - Injury Severity Score
- - Anatomic profile
- Mechanism of injury
- Combination systems
- - Trauma injury severity score
- - Pediatric age-adjusted trauma injury severity score (PAAT)
- - A severity characterization of trauma (ASCOT)
- - Pediatric Risk of Mortality (PRISM III)
- - Pediatric Index of Mortality 3 (PIM3)
- - International classification injury severity score (ICISS)
- - Pediatric trauma BIG score
- PREDICTIVE VALUE