title: Systematic review and need assessment of pediatric trauma outcome benchmarking tools for low-resource settings.
abstract: BACKGROUND
  Trauma is a leading cause of mortality and disability in children worldwide. The World Health Organization reports that 95% of all childhood injury deaths occur in Low-Middle-Income Countries (LMIC). Injury scores have been developed to facilitate risk stratification, clinical decision making, and research. Trauma registries in LMIC depend on adapted trauma scores that do not rely on investigations that require unavailable material or human resources. We sought to review and assess the existing trauma scores used in pediatric patients. Our objective is to determine their wideness of use, validity, setting of use, outcome measures, and criticisms. We believe that there is a need for an adapted trauma score developed specifically for pediatric patients in low-resource settings.
  
  
  METHODS
  A systematic review of the literature was conducted to identify and compare existing injury scores used in pediatric patients. We constructed a search strategy in collaboration with a senior hospital librarian. Multiple databases were searched, including Embase, Medline, and the Cochrane Central Register of Controlled Trials. Articles were selected based on predefined inclusion criteria by two reviewers and underwent qualitative analysis.
  
  
  RESULTS
  The scores identified are suboptimal for use in pediatric patients in low-resource settings due to various factors, including reliance on precise anatomic diagnosis, physiologic parameters maladapted to pediatric patients, or laboratory data with inconsistent accessibility in LMIC.
  
  
  CONCLUSIONS
  An important gap exists in our ability to simply and reliably estimate injury severity in pediatric patients and predict their associated probability of outcomes in settings, where resources are limited. An ideal score should be easy to calculate using point-of-care data that are readily available in LMIC, and can be easily adapted to the specific physiologic variations of different age groups.
authors.affiliation: Centre for Global Surgery, McGill University Health Centre, Montreal, QC, Canada. etienne.st-louis@mail.mcgill.ca.
authors.forename: Etienne
authors.identifier: http://orcid.org/0000-0002-2831-2642
authors.initials: E
authors.lastname: St-Louis
authors.affiliation: Division of Pediatric Emergency Medicine, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Jade
authors.initials: J
authors.lastname: Séguin
authors.affiliation: Department of Surgery, Hospital del Trabajador, Santiago, Chile.
authors.forename: Daniel
authors.initials: D
authors.lastname: Roizblatt
authors.affiliation: Centre for Global Surgery, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Dan Leon
authors.initials: DL
authors.lastname: Deckelbaum
authors.affiliation: Department of Pediatric Surgery, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Baird
authors.affiliation: Centre for Global Surgery, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Tarek
authors.initials: T
authors.lastname: Razek
mesh_terms: D019985:Benchmarking / Q000379:methods*; D002648:Child; D003906:Developing Countries; D006801:Humans; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011203:Poverty; D012042:Registries; D014947:Wounds and Injuries / Q000628:therapy*
keywords: Benchmarking tool; Pediatric trauma; Systematic review; Trauma score