Systematic review and need assessment of pediatric trauma outcome benchmarking tools for low-resource settings
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.
Materials and methods
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.
KeywordsPediatric trauma Benchmarking tool Trauma score Systematic review
E. St-Louis is funded by the Surgeon Scientist Program at McGill University, the Canadian Institute of Health Research (CIHR), and the Fonds de recherche du Québec en Santé (FRQS). The Centre for Global Surgery was supported by the Montreal General Hospital Foundation.
- 3.United Nations Millenium Development Project Goals. http://www.unmillenniumproject.org/goals/. Accessed 7 June 2016
- 5.Canadian Health Services Research Foundation and Canadian Institutes of Health Research IoHSaPR. Listening for direction: final report to Health Canada 2007. http://www.chsrf.ca/Libraries/Listening_for_Direction/LfDIII-NRFinal_ENG_05_09_08.sflb.ashx. Accessed 29 Sept 2014
- 6.Canada SK (2006 ) Child and youth unintentional injury: 1994–2003; 10 years in review. http://www.mhp.gov.on.ca/en/prevention/injury-prevention/skc_injuries.pdf. Accessed 29 Sept 2014
- 14.Reilly PL, Simpson DA et al (1988) Assessing the conscious level in infants and young children: a paediatric version of the Glasgow Coma Scale. Child’s Nerv Syst 4:30–33Google Scholar
- 18.Aprahamian C, Cattey RP et al (1990) Pediatric Trauma Score, predictor of hospital use ? Arch Surg 125(1128):1131Google Scholar
- 41.Orliaguet GA, Meyer PG et al (1998) Predictive factors of outcome in severely traumatized children. Pediatr Anesth 87:537–542Google Scholar
- 64.Burd RS, Jang TS, Nair SS (2006) Predicting hospital mortality among injured children using a national trauma database. J Trauma 60(792):801Google Scholar
- 65.Ducrocq SC, Meyer PG, et al (2006) Epidemiology and early predictive factors of mortality and outcome in children with traumatic severe brain injury: experience of a French pediatric trauma center. Pediatr Crit Care Med 7(5):461, 467Google Scholar
- 73.Hariharan S, Chen D et al (2007) Evaluation of trauma care applying TRISS methodology in a Carribean developing country. Int Emerg Med 9:85–90Google Scholar
- 75.Karam O, Sanchez O et al (2009) Blunt abdominal trauma in children: a score to predict the absence of organ injury. J Pediatr 154(6):912–917Google Scholar
- 88.The World Bank New Country Classifications. http://data.worldbank.org/news/new-country-classifications. Accessed 21 May 2016
- 90.Copes WS, Sacco WJ et al. Progress in characterising anatomic injury. In: Proceedings of the 33rd annual meeting of the association for the advancement of automotive medicine, Baltimore MA, USA, pp 205–218Google Scholar
- 102.Hoffman F, Schmalhofer M et al (2016) Comparison of the AVPU Scale and the pediatric GCS in prehospital setting. Prehosp Emerg Care 20(4):493–498Google Scholar
- 103.Committee on Trauma, American College of Surgeons (2008) Chapter 10: pediatric surgery. In: ATLS: advanced trauma life support program for doctors (8th ed). American College of Surgeons, ChicagoGoogle Scholar
- 104.Chan M (2012) From new estimates to better data. Lancet 380(9859):2054Google Scholar
- 105.Murray CJ, Vos T et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2197–2223Google Scholar
- 106.World Health Organization (2009) Chapter 4: techniques of quality improvement. In: Guidelines for trauma quality improvement programmes. World Health Organization, p 44Google Scholar