Predictive Value of Clinical and Trauma Scores for Life-Saving Interventions in Pediatric Trauma Patients: A Retrospecti̇ve Cohort Study

Purpose Early identification of pediatric trauma patients requiring life-saving interventions (LSIs) is fundamental for optimizing emergency triage and allocation planning. This study aimed to evaluate and compare the predictive effectiveness of the Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), Pediatric Trauma Score (PTS), Shock Index Pediatric Age-Adjusted (SIPA) score, and BIG score for determining LSI requirements in a pediatric emergency trauma population. Methods A retrospective observational study was conducted at the Pediatric Emergency Department of Hacettepe University, a Level I pediatric trauma center, between January 2019 and December 2022. Patients aged 0–18 years presenting within one hour of injury and observed for ≥ 8 hours were enrolled. Demographic, clinical, laboratory, and injury scoring data were systematically collected. Multivariable logistic regression analysis was performed to identify independent predictors of LSI requirement. Results A total of 560 patients were included (mean age 91.4 ± 70.3 months; 64.6% male), of whom 32.1% required LSIs. On multivariable analysis, higher AIS (AOR 6.39, 95% CI 3.79–10.79), higher ISS (AOR 1.23, 95% CI 1.16–1.31), elevated SIPA score (AOR 3.41, 95% CI 1.86–6.25), and elevated serum lactate (AOR 1.16, 95% CI 1.03–1.30) were independently associated with LSI requirement. Higher PTS (AOR 0.54) and higher GCS (AOR 0.54) were significantly associated with reduced odds of LSI. The BIG score did not demonstrate independent predictive significance after multivariable adjustment (p = 0.326). Overall mortality was 5.1%. Conclusion AIS, ISS, SIPA score, serum lactate, and GCS are reliable independent predictors of LSI requirement in pediatric trauma patients. The BIG score demonstrated limited utility for early LSI decision-making in this cohort. A multiparametric approach integrating injury severity, hemodynamic, metabolic, and neurological parameters provide a more solid framework for early risk stratification in pediatric emergency trauma management.