Definition and epidemiology
The Pediatric Trauma Score (PTS) is a physiology-and-anatomy triage tool introduced by Tepas and colleagues in 1987 to quantify injury severity in children, in whom adult scoring (and adult anatomy and physiological reserve) translates poorly. Trauma remains a leading cause of childhood death, and small children are uniquely vulnerable to airway compromise, hypothermia, and occult haemorrhage. The PTS was designed specifically to capture these size- and physiology-related risks and to support field triage to a paediatric-capable trauma centre.
Clinical features
The injured child may present deceptively well-compensated: children maintain blood pressure until late and then decompensate abruptly, so isolated systolic pressure is an insensitive marker of shock. Relevant features span the airway (patency and the support needed to maintain it), neurologic status (awake versus obtunded versus comatose), and anatomic injury (open wounds and fractures), all weighted alongside body size as a surrogate for the fragility of the very young. Small body mass spreads transferred energy across more organs, a large head raises the burden of head injury, and a high surface-area-to-mass ratio accelerates heat loss — so a child can harbour serious internal injury behind unremarkable initial vital signs, and reassuring early numbers must never close the assessment.
Diagnosis
The PTS sums six components — size, airway, systolic blood pressure, central nervous system status, open wound, and skeletal injury (fractures) — each scored +2, +1, or −1, giving a total range of −6 to +12. A higher score indicates a less severely injured child. The widely used triage threshold is ≤8, which warrants transfer to a paediatric trauma centre; lower scores predict progressively higher mortality, with scores below zero historically associated with very high mortality and scores above 8 with negligible mortality. The PTS is a triage and risk-stratification aid, not a substitute for serial clinical assessment.
See the full criteria: Pediatric Trauma Score
Red flags
- PTS ≤8 — triage to a paediatric trauma centre
- Unmaintainable airway or the need for an artificial airway
- Systolic pressure in the low band, tachycardia, or delayed capillary refill (compensated shock)
- Coma, decerebrate posturing, or a falling level of consciousness
- Major or penetrating open wounds and multiple/open fractures
Management overview
Resuscitation follows a structured ATLS/trauma primary survey — airway with cervical-spine protection, breathing, circulation with haemorrhage control, disability, and exposure with aggressive prevention of hypothermia. Secure the airway early in the obtunded child, control external bleeding, and resuscitate hypoperfusion with weight-based isotonic crystalloid, moving to blood products for ongoing haemorrhage. Reassess frequently, because children compensate then crash; a normal first set of vitals does not exclude significant injury. Use the PTS to prioritise transport and activate trauma-team and surgical resources, then proceed to definitive imaging and management of identified injuries at the receiving centre.
References
- Tepas JJ, et al. The pediatric trauma score as a predictor of injury severity in the injured child. J Pediatr Surg. 1987.
- Tepas JJ, et al. Pediatric trauma score: is it reliable in predicting mortality? Pediatr Surg Int.
- American College of Surgeons. Resources for Optimal Care of the Injured Patient.
Decision support for qualified clinicians only — verify against current primary guidelines and your clinical judgement.