The Prognostic Value of Trauma Score, Injury Severity Score, and Pediatric BIG Scores in Pediatric Firearm Injuries

INTRODUCTION: Firearm injuries represent a major cause of morbidity and mortality in pediatric emergency departments. Their management requires a multidisciplinary approach, including airway stabilization, circulatory support, hemostasis, resuscitation, and emergency surgical intervention. This study aimed to evaluate the predictive performance of the Pediatric Trauma Score (PTS), Revised Trauma Score (RTS), Injury Severity Score (ISS), and Pediatric BIG (PBIG) score for mortality. MATERIALS AND METHODS: This retrospective cohort study was conducted at a high-volume, urban, tertiary care, university-affiliated pediatric emergency department embedded within a major regional trauma center in Turkey. Patients aged 1 to 18 years with firearm injuries were tracked between January 1, 2021, and May 30, 2024. Trauma scores were calculated for each patient from baseline admission data. RESULTS: Among 353 patients (81.6% male; mean age: 13.9±3.8 y), overall mortality was 5.4% (n=19). The RTS exhibited superior mortality prediction (AUC: 0.991, 95% CI: 0.987-0.995; cutoff <5.26), followed by PTS (AUC: 0.988), Injury Severity Score (AUC: 0.969), PBIG score (n=135, AUC: 0.957, cutoff >16.35), and Glasgow Coma Scale (GCS; AUC: 0.938) (all P <0.001). In multivariable regression, the RTS emerged as the sole independent predictor of in-hospital mortality (adjusted OR=0.125, 95% CI: 0.039-0.402; P <0.001), while GCS and ISS lost independent significance. CONCLUSION: Multivariable modeling identifies the RTS as the sole independent predictor of mortality, whereas the ISS provides optimal accuracy for predicting intensive care admission. Integrating these laboratory-independent scores into automated electronic health record alerts can standardize secondary risk stratification and expedite resource allocation in pediatric firearm trauma.