Multiple Trauma in Children: Predicting Outcome and Long-term Results

Objective: To analyze the management of pediatric trauma and the efficacy of the Pediatric Trauma Score (PTS) in classifying injury severity and predicting prognosis.

Design: A retrospective case series.

Setting: The Children's Hospital of Eastern Ontario, a major pediatric trauma centre.

Patients: One hundred and forty-nine traumatized children with 2 or more injuries to 1 body system or a single injury to 2 or more body systems.

Interventions: Use of the PTS and Glasgow Coma Scale score in trauma management.

Main Outcome Measures: Types of injuries sustained, complications, missed injuries, psychosocial effects and residual deficiencies.

Results: The average PTS was 8.5 (range from -3 to 11). The total number of injuries sustained was 494, most commonly closed head injury (86). Forty-two percent of children with an average trauma score of 8.5 were treated surgically. There were 13 missed injuries, and complications were encountered in 57 children, the most common being secondary to fractures. Forty-eight (32%) children had residual long-term deficiency, most commonly neurologic deficiency secondary to head injury.

Conclusions: Fractures should be stabilized early to decrease long-term complications. A deficiency of the PTS is the weighting of open fractures of a minor bone. For example, metacarpal fracture is given the same weight as an open fracture of the femur. Neuropsychologic difficulties secondary to trauma are a major sequela of trauma in children.