Pediatric Trauma Score (PTS)

Why did you develop the Pediatric Trauma Score (PTS)? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

The PTS was initially developed to help prehospital providers assess injured children at the scene. The pediatric component of the Advanced Trauma Life Support (ATLS) program was just being written, and we wanted to emphasize a similar assessment protocol for triage. It begins with size, then consciousness, airway, BP, extremity fracture, then external injury.

What pearls, pitfalls and/or tips do you have for users of the Pediatric Trauma Score (PTS)? Do you know of cases when it has been applied, interpreted, or used inappropriately?

The literature has many reports of its use, especially in mass casualty events. The most important thing to remember is that it is designed to identify risk. It is biased to project greater fragility for the smaller child, one who is obtunded, or who has open wounds or fractures.

One caveat about use of all triage scores: they are NOT designed as risk adjusters! However, some studies are using them as such. They are points on a curve that should reflect a trend of improvement from therapy.

What recommendations do you have for doctors once they have applied the Pediatric Trauma Score (PTS)? Are there any adjustments or updates you would make to the score based on new data or practice changes?

It has needed no revision as a tool designed to guide the rescuer to look at the critical elements and determine risk. With the maturation of trauma systems and development of pediatric trauma centers, it has been supplanted by policy in many areas.

How do you use the Pediatric Trauma Score (PTS) in your own clinical practice? Can you give an example of a scenario in which you use it?

Interestingly, as we assess the experience with pediatric trauma and see the primacy of TBI, more rapid transport to appropriate neurosurgical care (Brain alert?) may become increasingly important. PTS may be the tool for this.

What were the results of the field testing mentioned at the end of the article in the discussion section?

Effective triage tool. Many reports, would suggest literature search.

Any other research in the pipeline that you’re particularly excited about?

Brain alert!

What do you mean by “brain alert”?

PTS was developed in 1984 as a process based on what was then the new ATLS to guide field personnel through an organized assessment of the injured child. Our goal was to establish effective principles of management of pediatric injury.

Today we have a far more sophisticated EMS system. Part of that system includes better analysis of how the system works. As a regional pediatric trauma center, we have noticed a significant volume of TBI who are not immediately recognized as such, and therefore slide “under the radar” through a slower process of hospital triage, often losing precious time that might have translated to better outcome.

We are therefore espousing the concept of “brain alert” to heighten EMS sensitivities to subtle findings that should stimulate immediate transport to the pediatric trauma center. We are currently doing an extensive data analysis to identify what additional findings would define “brain alert,” so there is more to come.

Stated differently, the pediatric trauma system needs to be re-engineered.

Joseph J. Tepas III, MD, FACS, FAAP, is an emeritus professor in the department of surgery at University of Florida (UF) College of Medicine in Gainesville, Florida. He is a member of numerous editorial boards of scientific journals and is the author of 215 peer-reviewed publications, 30 book chapters, and 260 national and international presentations. Dr. Tepas’ current research activities include NIH-funded investigation of biomarkers of acute brain injury and multi-institutional investigation of the role of biomarkers of metabolic derangement in defining timing and technique of operative intervention in high risk premature infants with necrotizing enterocolitis.