Applicability of the Revised Trauma Score in Paediatric Patients Admitted to a South African Intensive Care Unit: A Retrospective Cohort Study

CONTEXT: Revised Trauma Score (RTS) is a validated tool in assessing patients in a pre-hospital setting. There are limited data describing its potential use in guiding referral to intensive care. AIMS: Trauma scoring systems require appropriate validation in a local setting before effective application. This work examines the applicability of RTS to a paediatric intensive care trauma population. SETTINGS AND DESIGN: A retrospective record review of trauma patients admitted to the paediatric intensive care unit at Chris Hani Baragwanath Academic Hospital between 2011 and 2013 was performed. SUBJECTS AND METHODS: The cohort was arbitrarily split into three subgroups based on RTS using the 33(rd) and 66(th) percentile values and groups compared. Outcome measures examined included mortality, age, gender, length of stay (LoS), duration of ventilation (DoV) and change in Glasgow Coma Scale (GCS) from admission to discharge. STATISTICAL ANALYSIS USED: Categorical values examined with Fisher's exact test. Non-categorical values examined with the Kruskal–Wallis and Dunn's multiple comparisons tests. RESULTS: Of 919 children admitted, 165 admissions were secondary to trauma. Data necessary for calculation of RTS were available in 91 patients. The mean RTS was 5.3, 33(rd) percentile was 4.7 and 66(th) was 5.9. DoV (P = 0.0104) and LoS (P = 0.0395) were significantly different between intermediate- and low-risk groups as was change in GCS between low-risk and both other groups (P < 0.0001). CONCLUSIONS: RTS is not predictive of mortality between high-risk (RTS < 4.09) and low-risk patients (RTS > 5.67) in this population. It may be useful in predicting other outcomes such as DoV and LoS.