The prognostic importance of trauma scoring systems for morbidity in children with penetrating abdominal wounds: 17 years of experience

doi:10.1053/jpsu.2002.29436

Journal of Pediatric Surgery

Volume 37, Issue 1, January 2002, Pages 93-98

https://doi.org/10.1053/jpsu.2002.29436 Get rights and content

Abstract

Background/Purpose: Risk factors that may independently predict morbidity in children with penetrating abdominal wounds (PAW) have not been elucidated fully. The aim of this study was to identify not only correlated risk factors for morbidity in children with PAW, but also to evaluate the independent predictive value of 3 different trauma scoring systems: the Injury Severity Score (ISS), the Penetrating Abdominal Trauma Index (PATI), and the Pediatric Trauma Score (PTS). Methods: Between January 1983 and November 2000, 119 children (99 boys, 20 girls) presenting with PAW were reevaluated by an analysis of the relationship between overall morbidity and potential risk factors. Results: Wounds were caused by firearm trauma in 85 children and stabbing in 34. Univariate analysis found that age greater than 10 years, trauma mechanism, number of intraabdominal organs injured (NOI) greater than 2, presence of penetrating injury, and ISS and PATI score were associated with greater than 3-fold increased incidence of morbidity (P <.05). The relative risk of a postoperative septic complication was higher than 2 for the following risk factors: age greater than 10 years, shotgun injury, number of organs injured greater than 2, presence of colon injury, ISS greater than 15, and PATI score greater than 15. Multivariate analysis showed that only ISS (P =.02), and PATI score (P =.03) were independently significant in predicting morbidity. Conclusion: ISS and PATI score were the most important indicators found to be independently associated with morbidity. J Pediatr Surg 37:93-98. Copyright © 2002 by W.B. Saunders Company.

Section snippets

Materials and methods

Between January 1983 and November 2000, 143 children under 15 years of age with PAW (firearm trauma in 85, stabbing in 58) were admitted to the Pediatric Surgical Department of Dicle University Medical School. No patient underwent a negative laparotomy after a firearm wound in proximity to the abdomen. Twelve children with penetrating peritoneal stab injuries presented no abdominal organ pathology during laparotomy. These 12 patients and another conservatively managed 12 patients were all

Results

There were 99 boys (83%) and 20 girls (17%), with a mean age of 10.1 ± 3.3 years (range, 3-15 years). The mean hospitalization time was 8.9 ± 5 days (range, 1-60 days). The overall mean duration of hospital stay in the series was 8.9 days; the mean stay for patients with and without postoperative complication was 14.7 days and 8.4 days, respectively. The mortality rate for the series was 1.6%. Two patients died; one with a shotgun injury, of septicemia on the first day of admission; and the

Discussion

There has been a great deal of development and progress in trauma care institutions in the last 3 decades. To decrease the morbidity and mortality rates associated with trauma, rapid triage and transport of the critically injured patient to an appropriate center is crucial. To assist in the appropriate transfer of patients, trauma triage scoring systems have been developed; they have evolved to provide a measure of risk-adjusted mortality as well. In our study we aimed to evaluate whether the

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Citation Excerpt :
In an effort to offer a predictive measure for isolated abdominal trauma, the penetrating abdominal trauma index (PATI) was formulated in 1981 [17]. Few studies have directly compared its utility to the other most commonly used injury-severity scoring system, the ISS [18,20,21]. For LMICs with a high burden of relevant injuries [10–12], even less is known.
Penetrating abdominal trauma is a common feature of trauma treated in low- and middle-income countries (LMICs). The penetrating abdominal trauma index (PATI) and the injury severity score (ISS) are severity-measures most often used to gauge injury severity. It remains unclear which measure better accounts for the severity of sustained injuries. This study compares the predictive ability of both injury severity measures in patients presenting to an LMIC in South Asia.
All isolated gunshot wounds to the abdomen presenting to a university hospital between 2011 and 2012 were included. ISS and PATI were calculated for each case. Primary outcome measures included all-cause mortality and complications. Multivariable analysis adjusting for age, sex, referral status, hypotension, tachycardia, and injury severity measures was performed. The area under the receiver operating characteristic (AUROC) curve were further calculated to compare the respective abilities of ISS and PATI at predicting death and complications.
A total of 70 patients were included. The average age on presentation was 34.5 y (±11.4) within a predominantly male (n = 68, 97.1%) cohort. Most gunshot wounds were intentionally inflicted (n = 67, 95.7%). The crude rates of death and complications were 34.3% and 15.7%, respectively. The median ISS was 14 (interquartile range: 11–21), and the median PATI was 16 (interquartile range: 9–26). AUROC analysis revealed that ISS was comparable with PATI at predicting mortality (AUROC [95% confidence interval]: 0.952 [0.902–1.00] versus 0.934 [0.860–1.00]) and complications (AUROC [95% confidence interval]: 0.868 [0.778–0.959] versus 0.895 [0.815–0.975]).
The predictive ability of ISS and PATI severity measures was found to be comparable. The results suggest that both measures can be used to risk-stratify patients with isolated abdominal gunshot wounds in an LMIC.
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^☆: Address reprint requests to Hayrettin Öztürk, MD, Dicle University Medical School, Department of Paediatric Surgery, 21280 Diyarbakir, Turkey.

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The prognostic importance of trauma scoring systems for morbidity in children with penetrating abdominal wounds: 17 years of experience☆

Abstract

Section snippets

Materials and methods

Results

Discussion

Pediatr Clin North Am

J Pediatr Surg

J Pediatr Surg

Am J Surg

J Pediatr Surg

Injury

The outcome for children with blunt trauma is best at a pediatric trauma center

J Pediatr Surg

Abdominal gunshot wounds: An urban trauma center's experience with 300 consecutive patients

Ann Surg

Shotgun injuries in pediatric patients

South Med J

The new epidemic in children: Penetrating Injuries

J Trauma

Outcome of treatment of 686 gunshot wounds of the trunk at Los Angeles County-USC medical center: Implications for the community

J Trauma

A correlation of response time and the results of abdominal gunshot wounds

Arch Surg

Are scene flights for penetrating trauma justified?

J Trauma

Helicopter emergency medical services: Their role in integrated trauma care

Aust N Z J Surg