Pediatric trauma smackdown: PTS vs SIPA

Abstract

Background: Different scoring tools aid prediction of pediatric trauma patients' prognosis but there's no consensus on when to apply each. Pediatric Trauma Score (PTS) was one of the first tools developed. Shock Index Pediatric Adjusted (SIPA) adapts Shock Index (SI) in predicting outcomes adjusted for age. It is unclear if either scoring tool is better at predicting outcomes.

Objective: To compare SIPA and PTS for level I and II pediatric traumas to determine if both are equally effective in predicting outcomes for pediatric trauma patients.

Design/methods: This is a retrospective review of patients 1-17 years with level 1 and 2 activated trauma (1/2013 - 11/2019).

Outcomes of interest: disposition, length of stay, ventilator use, moderate/major spleen/liver lacerations, and Index Severity Score (ISS). Patient visits were scored using both scores and placed into high/low risk category as predefined by the individual scoring tools: High risk SIPA, low risk SIPA, high risk PTS, low risk PTS.

Results: There were 750 patients who met inclusion criteria, 35 visits scored high with both tools and 543 visits scored low. The odds ratio (OR) for each tool showed high risk scores were more likely to be associated with increased likelihood of outcomes. When both high-risk groups were compared, PTS had an increased OR for most outcomes. SIPA had an increased OR for receiving fluid bolus.

Conclusion: This study externally validates both scoring tools for the same cohort. Both tools were reliable predictors, but PTS identifies more "high risk" visits. PTS requires more variables to calculate than SIPA. SIPA may be an effective way to triage when resources are scarce. However, there's still a need for a pediatric trauma triage score that can encompass the accuracy of PTS and the convenience of SIPA.

Keywords: PTS; Pediatric emergency; Pediatric trauma; Pediatric trauma score; SIPA; Shock index pediatric adjusted; Trauma triage, Trauma triage score.