Potoka et al developed a pediatric trauma score using age-related reference ranges for physiologic measures. This can help identify a child at high risk for mortality. The authors are from the University of Pittsburgh and the Children's Hospital of Pittsburgh.
Age range: 0 to 16 years of age
Parameters:
(1) Glasgow Coma Score (GCS)
(2) systolic blood pressure
(3) pulse
(4) respiratory rate
Parameter |
Finding |
Points |
---|---|---|
Glasgow Coma Score |
14 – 15 |
3 |
|
10 – 13 |
2 |
|
4 – 9 |
1 |
|
3 |
0 |
systolic blood pressure |
normal (mean for age) +/- (1 SD) |
3 |
|
mild to moderate hypotension (blood pressure) < (mean for age) – (2 SD) |
2 |
|
severe hypotension (blood pressure) < (mean for age) – (3 SD) |
1 |
|
0 |
0 |
pulse |
normal (mean for age) +/- (1 SD) |
3 |
|
tachycardia (pulse) > (mean for age) + (1 SD) |
2 |
|
bradycardia (pulse) < (mean for age) – (1 SD) |
1 |
|
0 |
0 |
respiratory rate |
normal (mean for age) +/- (1 SD) |
3 |
|
tachypnea (respiratory rate) > (mean for age) + (1 SD) |
2 |
|
hypoventilation (respiratory rate) < (mean for age) – (1 SD) |
1 |
|
0 |
0 |
|
intubated |
0 |
where:
• I would have thought that mild hypotension would be (blood pressure) – (1 SD) to (blood pressure) – (2 SD).
• There is no scoring for hypertension.
Age |
Systolic Blood Pressure in mm Hg |
Pulse |
Respiratory Rate |
|||
---|---|---|---|---|---|---|
|
M - 2 SD |
M - 3 SD |
M + 1 SD |
M - 1 SD |
M + 1 SD |
M - 1 SD |
0 |
60 |
35 |
180 |
120 |
45 |
19 |
0.5 |
65 |
40 |
170 |
115 |
41 |
17 |
1 |
70 |
44 |
165 |
110 |
37 |
15 |
2 |
77 |
57 |
150 |
100 |
34 |
14 |
3 |
76 |
54 |
145 |
95 |
33 |
15 |
4 |
82 |
65 |
140 |
92 |
33 |
15 |
5 |
80 |
60 |
132 |
90 |
30 |
16 |
6 |
83 |
65 |
130 |
88 |
28 |
16 |
7 |
82 |
63 |
126 |
88 |
28 |
14 |
8 |
86 |
68 |
124 |
86 |
28 |
14 |
9 |
88 |
72 |
120 |
84 |
28 |
14 |
10 |
88 |
70 |
120 |
80 |
28 |
14 |
11 |
90 |
72 |
120 |
78 |
28 |
14 |
12 |
90 |
70 |
120 |
76 |
28 |
14 |
13 |
90 |
70 |
120 |
76 |
28 |
14 |
14 |
90 |
70 |
120 |
76 |
28 |
14 |
15 |
90 |
70 |
120 |
76 |
26 |
12 |
16 |
90 |
70 |
120 |
76 |
26 |
12 |
extracted from plots in Figure 1, page 108
total ASPTS =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score, the better the prognosis.
Score |
Probability of Mortality |
Probability ISS > 20 |
---|---|---|
12 |
0% |
5% |
11 |
0% |
19.9% |
10 |
0.3% |
8.8% |
9 |
5.4% |
36.6% |
8 |
9.3% |
41% |
7 |
11.4% |
54.5% |
6 |
20.6% |
55.4% |
5 |
28.3% |
58.6% |
4 |
55% |
72.5% |
3 |
83.4% |
67.7% |
2 |
100% |
57.1% |
1 |
100% |
62.5% |
0 |
100% |
63.8% |
from Table 3, page 108
Performance:
• Using a total ASPTS < 10 as the indicator for mortality, the sensitivity for mortality is 97% and specificity is 89%.
• Using a total ASPTS < 8 as the indicator for mortality, the sensitivity for mortality is 91% and specificity is 94%.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general, Pedatrics