{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T22:48:00Z","timestamp":1779230880395,"version":"3.51.4"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n            <jats:title>Objectives<\/jats:title>\n            <jats:p>Recent work has questioned the accuracy of the Injury Severity Score (ISS) and the Abbreviated Injury Scale (AIS) in the pediatric population. We sought to determine mortality rates in pediatric trauma patients at ISSs considered \u201csevere\u201d in adults and whether mortality would vary substantially between adults and children sustaining injuries with the same AIS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Univariate logistic regression was used to generate mortality rates associated with ISS scores, for children (&lt;16 years of age) and adults, using the 2016 National Trauma Data Bank. Mortality rates at an ISS of 15 were calculated in both groups. We similarly calculated ISS scores associated with mortality rates of 10%, 25%, and 50%. Receiver operating characteristic curves were constructed to compare the discriminative ability of ISS to predict mortality after blunt and penetrating injuries in adults and children. Mortality rates associated with 1 or more AIS 3 injuries per body region were defined.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>There were 855,454 cases, 86,414 (10.1%) of which were children. The ISS associated with 10%, 25%, and 50% mortality were 35, 44, and 53, respectively, in children; they were 27, 38, and 48 in adults. At an ISS of 15, pediatric mortality was 1.0%; in adults, it was 3.1%. A 3.1% mortality rate was not observed in children until an ISS of 25. On receiver operating characteristic analysis, the ISS performed better in children compared with adults (area under the curve, 0.965 vs 0.860 [<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001]). Adults consistently suffered from higher mortality rates than did children with the same number of severe injuries to a body region, and mortality varied widely between specific selected AIS 3 injuries.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Although the ISS predicts mortality well, children have lower mortality than do adults for the same ISS, and therefore, the accepted definition of severe injury is not equivalent between these 2 cohorts. Mortality risk is highly dependent on the specific nature of the injury, with large variability in outcomes despite identical AIS scores.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000002363","type":"journal-article","created":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T08:56:15Z","timestamp":1614243375000},"page":"e828-e832","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["Settling the Score"],"prefix":"10.1097","volume":"38","author":[{"given":"Justin S.","family":"Hatchimonji","sequence":"first","affiliation":[{"name":"Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie L.","family":"Luks","sequence":"additional","affiliation":[{"name":"Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A.","family":"Swendiman","sequence":"additional","affiliation":[{"name":"Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Myron","family":"Allukian","sequence":"additional","affiliation":[{"name":"Division of Pediatric General, Thoracic and Fetal Surgery, Children\u2019s Hospital of Philadelphia, Philadelphia, PA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael L.","family":"Nance","sequence":"additional","affiliation":[{"name":"Division of Pediatric General, Thoracic and Fetal Surgery, Children\u2019s Hospital of Philadelphia, Philadelphia, PA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary W.","family":"Nace","sequence":"additional","affiliation":[{"name":"Division of Pediatric General, Thoracic and Fetal Surgery, Children\u2019s Hospital of Philadelphia, Philadelphia, PA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2021,2,9]]},"reference":[{"key":"bib2-20250504","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/0735-6757(84)90081-0","article-title":"Injury severity scales: overview and directions for future research","volume":"2","year":"1984","journal-title":"Am J Emerg Med"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/00006565-199906000-00013","article-title":"ABCs of scoring systems for pediatric trauma","volume":"15","year":"1999","journal-title":"Pediatr Emerg Care"},{"key":"bib4-20250504","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/00005373-197403000-00001","article-title":"The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care","volume":"14","year":"1974","journal-title":"J Trauma"},{"key":"bib5-20250504","first-page":"13","article-title":"Major trauma and the injury severity score\u2014where should we set the bar?","volume":"51","year":"2007","journal-title":"Annu Proc Assoc Adv Automot Med"},{"key":"bib6-20250504","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1001\/jama.1971.03180150059012","article-title":"Rating the severity of tissue damage. 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