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Assess pediatric trauma severity and predict outcomes. The Pediatric Trauma Score helps determine the need for trauma center transfer and provides mortality risk stratification for injured children.
• This score is for initial triage and transfer decisions in pediatric trauma
• Score < 9 indicates need for pediatric trauma center transfer
• Do not delay life-saving interventions to calculate score
• Reassess frequently as pediatric patients can deteriorate rapidly
• Use in conjunction with clinical judgment and institutional protocols
• When in doubt, transfer to higher level of care
| Component | +2 | +1 | -1 |
|---|---|---|---|
| Weight | > 20 kg | 10-20 kg | < 10 kg |
| Airway | Normal | Maintainable | Unmaintainable |
| Systolic BP | > 90 mmHg | 50-90 mmHg | < 50 mmHg |
| Consciousness | Awake | Obtunded/LOC | Comatose |
| Open Wound | None | Minor | Major/Penetrating |
| Skeletal Injury | None | Closed fracture | Open/Multiple |
| PTS Score | Severity | Mortality Risk | Disposition |
|---|---|---|---|
| ≥ 9 | Minor | < 1% | Community hospital may be appropriate |
| ≤ 8 | Major | 10-25% | Transfer to pediatric trauma center |
| < 0 | Life-threatening | > 50% | Immediate highest-level trauma response |
The Pediatric Trauma Score (PTS) was developed to assess the severity of injury in children and predict outcomes. It evaluates six components: weight, airway status, blood pressure, level of consciousness, open wounds, and skeletal injuries. Each component is scored from -1 to +2, with total scores ranging from -6 to +12.
A score of 8 or less has been validated as a threshold for identifying children who require treatment at a pediatric trauma center. The PTS has high sensitivity for predicting mortality and need for intensive care in pediatric trauma patients.
Anatomic Differences:
Physiologic Differences:
Age-Specific Normal Ranges:
Minimum Acceptable Systolic BP by Age:
A - Airway (with C-spine protection):
B - Breathing and Ventilation:
C - Circulation with Hemorrhage Control:
D - Disability (Neurologic Status):
E - Exposure and Environmental Control:
Indications for Pediatric Trauma Center:
Mode of Transport:
Motor Vehicle Collisions:
Falls:
Non-Accidental Trauma (NAT):
The PTS serves two main purposes: (1) triage and transfer decisions - identifying which children need pediatric trauma center care (score ≤ 8), and (2) mortality prediction - estimating survival probability. It's designed to be calculated quickly at the scene or in the emergency department using readily observable parameters. The score helps ensure appropriate allocation of resources and timely transfer to facilities equipped for pediatric trauma.
Calculate PTS during initial assessment after stabilizing immediate life threats. Don't delay critical interventions to calculate the score. It's most useful for triage decisions, determining transfer needs, and communicating injury severity. Reassess the score if patient condition changes. The score can be calculated by EMS in the field, during ED evaluation, or when considering interfacility transfer. A low initial score should prompt immediate pediatric trauma center consultation.
The PTS accounts for pediatric-specific factors like weight (which affects medication dosing and physiology), different vital sign norms, and the unique injury patterns in children. Adult scores like the Trauma Score or Revised Trauma Score use different parameters and thresholds. Children have remarkable physiologic reserve and can maintain normal vital signs despite significant blood loss, then suddenly decompensate. The PTS -1 to +2 scale allows for more granular assessment appropriate for the pediatric population.
The PTS allows for clinical assessment when equipment isn't available. For blood pressure: palpable radial pulse generally indicates SBP > 90 mmHg (+2 points), palpable femoral/carotid pulse only suggests SBP 50-90 mmHg (+1 point), and no palpable pulse indicates SBP < 50 mmHg (-1 point). This clinical correlation makes the score practical in field settings. However, obtain actual blood pressure measurement as soon as possible for more accurate assessment and monitoring.
Weight is a surrogate for physiologic reserve and maturity. Smaller children (< 10 kg, typically infants) have less absolute blood volume, higher metabolic demands, less thermoregulatory capacity, and are at higher risk for poor outcomes from the same injury mechanism. Weight also affects medication dosing, equipment sizing, and fluid resuscitation calculations. The weight component helps identify the most vulnerable patients who need specialized pediatric care even with seemingly minor injuries.
Minor wounds are superficial lacerations or abrasions that don't significantly compromise tissue viability or function. Major wounds include penetrating injuries, deep lacerations involving tendons/nerves/vessels, degloving injuries, traumatic amputations, or wounds with significant tissue loss. When in doubt, err on the side of caution and score as major. The key is whether the wound represents significant tissue damage requiring surgical intervention or poses risk for complications like compartment syndrome or vascular compromise.
Yes, but with caution. The PTS was originally validated primarily for blunt trauma. Penetrating trauma (gunshot wounds, stabbings) often requires trauma center care regardless of PTS. Any penetrating injury to head, neck, torso, or proximal extremities should prompt immediate trauma center transfer. The PTS can still provide useful prognostic information and help communicate severity, but don't let a seemingly "acceptable" score delay transfer of a child with penetrating trauma. These injuries can deteriorate rapidly.
Stabilize ABCs, maintain C-spine precautions, establish IV/IO access, provide isotonic fluid resuscitation (20 mL/kg boluses as needed), prevent hypothermia (warming blankets, warm IV fluids), control obvious bleeding, splint fractures, provide analgesia, keep NPO, perform serial assessments and document, communicate frequently with accepting facility, prepare all medical records/imaging for transfer, and ensure family can accompany or follow if possible. Don't delay transfer for extensive testing at sending facility.