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Systematic review and need assessment of pediatric trauma outcome benchmarking tools for low-resource settings

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Abstract

Introduction

Trauma is a leading cause of mortality and disability in children worldwide. The World Health Organization reports that 95% of all childhood injury deaths occur in Low–Middle-Income Countries (LMIC). Injury scores have been developed to facilitate risk stratification, clinical decision making, and research. Trauma registries in LMIC depend on adapted trauma scores that do not rely on investigations that require unavailable material or human resources. We sought to review and assess the existing trauma scores used in pediatric patients. Our objective is to determine their wideness of use, validity, setting of use, outcome measures, and criticisms. We believe that there is a need for an adapted trauma score developed specifically for pediatric patients in low-resource settings.

Materials and methods

A systematic review of the literature was conducted to identify and compare existing injury scores used in pediatric patients. We constructed a search strategy in collaboration with a senior hospital librarian. Multiple databases were searched, including Embase, Medline, and the Cochrane Central Register of Controlled Trials. Articles were selected based on predefined inclusion criteria by two reviewers and underwent qualitative analysis.

Results

The scores identified are suboptimal for use in pediatric patients in low-resource settings due to various factors, including reliance on precise anatomic diagnosis, physiologic parameters maladapted to pediatric patients, or laboratory data with inconsistent accessibility in LMIC.

Conclusion

An important gap exists in our ability to simply and reliably estimate injury severity in pediatric patients and predict their associated probability of outcomes in settings, where resources are limited. An ideal score should be easy to calculate using point-of-care data that are readily available in LMIC, and can be easily adapted to the specific physiologic variations of different age groups.

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Acknowledgements

E. St-Louis is funded by the Surgeon Scientist Program at McGill University, the Canadian Institute of Health Research (CIHR), and the Fonds de recherche du Québec en Santé (FRQS). The Centre for Global Surgery was supported by the Montreal General Hospital Foundation.

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Authors and Affiliations

  1. Centre for Global Surgery, McGill University Health Centre, Montreal, QC, Canada

    Etienne St-Louis, Dan Leon Deckelbaum & Tarek Razek

  2. Division of Pediatric Emergency Medicine, McGill University Health Centre, Montreal, QC, Canada

    Jade Séguin

  3. Department of Surgery, Hospital del Trabajador, Santiago, Chile

    Daniel Roizblatt

  4. Department of Pediatric Surgery, McGill University Health Centre, Montreal, QC, Canada

    Robert Baird

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  1. Etienne St-Louis
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Correspondence to Etienne St-Louis.

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St-Louis, E., Séguin, J., Roizblatt, D. et al. Systematic review and need assessment of pediatric trauma outcome benchmarking tools for low-resource settings. Pediatr Surg Int 33, 299–309 (2017). https://doi.org/10.1007/s00383-016-4024-9

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