For healthcare professionals
Pediatric Trauma Score (PTS)
The Pediatric Trauma Score rates six findings in an injured child, each at +2, +1 or -1, for a total from -6 to +12. Lower scores mean more severe injury. This calculator is written for clinicians caring for an injured child and is not a diagnosis.
Score the six items
Items, levels and points as printed in Table 1 of Kim and colleagues (Kim 2021). Nothing you enter leaves this page.
What you will see
The total from -6 to +12 and whether it is at or below the published cut-off of 8.
Educational only, not medical advice. Not a diagnosis. Treatment and transfer decisions belong to the treating team.
Source
Items, levels and points as printed in Table 1 of Kim HJ and colleagues, Scientific Reports 2021 (open access, CC BY 4.0). Range of -6 to +12 and the cut-off of 8 or less as printed in De los Ríos-Pérez A and colleagues, Lancet Regional Health: Americas 2022 (open access, CC BY 4.0). Original scale: Tepas JJ and colleagues, Journal of Pediatric Surgery 1987 (cited only). Licences were checked in the Europe PMC full text. The tests check every item, both ends of the range and the cut-off.
Validated in
Kim 2021: 85 children under 15 with head injury who had an MRI after an emergency department visit at one hospital in South Korea, January 2015 to September 2020. De los Ríos-Pérez 2022: 1,047 children under 18 admitted after injury to one trauma centre in Cali, Colombia, 2011 to 2019.
Limits
Both studies are single-centre and retrospective. In the Colombian cohort, the cut-off that best separated survivors from deaths was 4, not 8, and two in three children scored 8 or less (De los Ríos-Pérez 2022). The Korean study looked at bleeding inside the skull in 85 children, not at survival (Kim 2021). The score does not replace a full trauma assessment.
Points table
| Item | +2 | +1 | -1 |
|---|---|---|---|
| Weight | More than 20 kg | 10 to 20 kg | Less than 10 kg |
| Airway | Patent | Maintainable | Unmaintainable |
| Systolic blood pressure | More than 90 mmHg | 50 to 90 mmHg | Less than 50 mmHg |
| Level of consciousness | Awake | Loss of consciousness | Comatose |
| Fractures | None | Closed or suspected | Multiple |
| Wounds | None | Minor | Major, penetrating, burns |
Source: Table 1 of Kim and colleagues 2021 (Kim 2021). The total is the sum of the six items, from -6 to +12, with lower scores meaning more severe injury (De los Ríos-Pérez 2022). The scale was first described by Tepas and colleagues in 1987 (Tepas 1987).
The cut-off of 8
A score of 8 or less suggests that the child should be transferred to a trauma centre because of a significantly increased risk of death (De los Ríos-Pérez 2022). Kim and colleagues describe 8 or less as the previously known value for critical injury (Kim 2021).
Worked example: a 15 kg child (+1) with a patent airway (+2), systolic blood pressure of 85 mmHg (+1), who is awake (+2), with a closed fracture (+1) and a minor wound (+1) scores 8, at the cut-off.
What studies found
In 1,047 injured children admitted to a trauma centre in Colombia, the median score was 7 and 62 children died. The score predicted survival with an area under the curve of 0.93. The best cut-off in that cohort was 4 (De los Ríos-Pérez 2022).
In 85 children with head injury who had an MRI in South Korea, the 95% confidence interval for the probability of bleeding inside the skull was 0.16% to 12.74% at scores of 11 or more and 35.86% to 89.14% at 9 to 10. All 7 children who scored 8 or less had bleeding (100%) (Kim 2021).
Related calculators
The SIPA pediatric shock index reads heart rate over systolic blood pressure against an age cut point, and the shock index calculator gives the unadjusted ratio. For a child with a head injury, see the PECARN head injury rule and the Pediatric Glasgow Coma Scale. Other bedside scores are listed under For healthcare professionals.
Sources
- Kim HJ, Eun S, Yoon SH, Kim MK, Chung HS, Koo C. Paediatric Trauma Score as a non-imaging tool for predicting intracranial haemorrhage in patients with traumatic brain injury. Sci Rep. 2021;11:20911. doi:10.1038/s41598-021-00419-y. PMID 34686729. Open access (CC BY 4.0). Table 1: Paediatric Trauma Score items and levels (+2, +1, -1); Table 4: intracranial haemorrhage by score group (8 or less, 9 to 10, 11 or more). pmc.ncbi.nlm.nih.gov/articles/PMC8536669/
- De los Ríos-Pérez A, García A, Cuello L, Rebolledo S, Fandíño-Losada A. Performance of the Paediatric Trauma Score on survival prediction of injured children at a major trauma centre: a retrospective Colombian cohort, 2011-2019. Lancet Reg Health Am. 2022;13:100312. doi:10.1016/j.lana.2022.100312. PMID 36777320. Open access (CC BY 4.0). Methods: the six PTS variables, range -6 to +12, a score of 8 or less and transfer to a trauma centre; results: AUROC 0.93 for survival in 1,047 children. pmc.ncbi.nlm.nih.gov/articles/PMC9903890/
- Tepas JJ 3rd, Mollitt DL, Talbert JL, Bryant M. The pediatric trauma score as a predictor of injury severity in the injured child. J Pediatr Surg. 1987;22(1):14-18. doi:10.1016/s0022-3468(87)80006-4. Original scale (cited only; not open access). doi.org/10.1016/s0022-3468(87)80006-4
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