The American journal of emergency medicine · 2025
Beyond survival: Early markers of poor outcome in pediatric trauma.
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Guvenc Kubra Boydag, Sahin Ebru Guney, Yılmaz Idris Abdullah, Ozturk Refik, Sahin Ceyhan, Varol Fatih, Durak Cansu
Аннотация
BACKGROUND: This study aimed to evaluate the prognostic value of clinical scoring systems and admission-based laboratory biomarkers in predicting mortality and morbidity among pediatric trauma patients.
METHODS: We conducted a retrospective analysis of 88 pediatric trauma patients admitted to a tertiary-level pediatric intensive care unit between August 2024 and July 2025. Patients who died within the first 24 h were excluded. PRISM III, PELOD-2, SIPA, GCS, and VIS scores were calculated on the day of admission. Laboratory parameters including lactate, procalcitonin, and albumin levels were recorded. Morbidity was defined as persistent organ-specific dysfunction at discharge. Receiver operating characteristic (ROC) analysis was used to evaluate predictive performance.
RESULTS: The overall mortality rate was 5.7 %, while 13.6 % of patients developed sequelae. Non-survivors had significantly higher PRISM III, PELOD-2, lactate, lactate/albumin ratio, and procalcitonin levels, along with longer PICU stay and greater need for mechanical ventilation and inotropic support. The lactate/albumin ratio showed the highest predictive value for mortality (AUC = 0.828). Patients with sequelae had significantly higher illness severity scores and elevated lactate-related markers. Transfusion needs were also more common in this group. Lactate/albumin ratio demonstrated strong negative predictive value (NPV = 95.6 %) for morbidity.
CONCLUSION: Both clinical severity scores and lactate-related biomarkers were associated with mortality and morbidity in pediatric trauma patients. In particular, the lactate/albumin ratio emerged as a useful early indicator of poor outcomes. These findings support the incorporation of combined scoring and biomarker strategies into early risk stratification protocols in pediatric trauma care.
METHODS: We conducted a retrospective analysis of 88 pediatric trauma patients admitted to a tertiary-level pediatric intensive care unit between August 2024 and July 2025. Patients who died within the first 24 h were excluded. PRISM III, PELOD-2, SIPA, GCS, and VIS scores were calculated on the day of admission. Laboratory parameters including lactate, procalcitonin, and albumin levels were recorded. Morbidity was defined as persistent organ-specific dysfunction at discharge. Receiver operating characteristic (ROC) analysis was used to evaluate predictive performance.
RESULTS: The overall mortality rate was 5.7 %, while 13.6 % of patients developed sequelae. Non-survivors had significantly higher PRISM III, PELOD-2, lactate, lactate/albumin ratio, and procalcitonin levels, along with longer PICU stay and greater need for mechanical ventilation and inotropic support. The lactate/albumin ratio showed the highest predictive value for mortality (AUC = 0.828). Patients with sequelae had significantly higher illness severity scores and elevated lactate-related markers. Transfusion needs were also more common in this group. Lactate/albumin ratio demonstrated strong negative predictive value (NPV = 95.6 %) for morbidity.
CONCLUSION: Both clinical severity scores and lactate-related biomarkers were associated with mortality and morbidity in pediatric trauma patients. In particular, the lactate/albumin ratio emerged as a useful early indicator of poor outcomes. These findings support the incorporation of combined scoring and biomarker strategies into early risk stratification protocols in pediatric trauma care.