Children's trauma score combined with blood lactate measurement provides clinical treatment guidance and prediction of recovery for children with compound injuries: a prospective study

Background Compound injuries in children are the leading cause of death and disability, and early and accurate assessment is crucial to optimize treatment. This study aimed to explore the clinical value of pediatric trauma score (PTS) combined with blood lactate measurement in the triage, treatment guidance and prognosis prediction of children's compound injuries. Methods From January 2023 to December 2024, a prospective, randomized, single-blind controlled trial was conducted in the emergency department of Hebei Provincial Children's Hospital (the only tertiary pediatric medical center in Hebei Province), China. A total of 546 children with combined injuries who visited the hospital were included and randomly divided into the intervention group (n = 273, managed by PTS combined with dynamic monitoring of blood lactate) and the control group (n = 273, managed by PTS only). The main outcome indicators are the timeliness of rescue (time to critical intervention) and the accuracy of prognosis prediction (predictive effectiveness of mortality and major complications). Secondary outcomes included emergency department length of stay, unplanned ICU admission, and 30-day complication rate. Results The median time from admission to initiation of key interventions was significantly shorter in the intervention group compared with the control group (45 [IQR: 30–65] minutes vs. 68 [IQR: 45–95] minutes, P < 0.001). The area under the receiver operating characteristic curve (AUC) of the combined indicator (PTS + initial lactate) to predict 30-day mortality was 0.936 (95% CI: 0.902–0.970), which was significantly higher than PTS alone (AUC: 0.812, P < 0.001) or initial lactate (AUC: 0.855, P = 0.002). The emergency stay time, unplanned ICU admission rate and 30-day complication rate of the intervention group were significantly lower than those of the control group (all P < 0.05). Dynamic monitoring showed that 6-hour lactate clearance < 30% was a strong independent predictor of the occurrence of multiple organ dysfunction syndrome (OR = 5.42, 95% CI: 2.88–10.21, P < 0. 001)。 Conclusion The combined application of PTS and blood lactate integrates physiological status and metabolic information, which can significantly improve the accuracy of early triage of children's compound injuries, guide the implementation of rescue measures, and effectively predict prognosis through dynamic monitoring, providing a reliable basis for precise individual management.