Pediatric Trauma Support System (PTSS) as a Tool for Automated Assessment of Trauma in Children

Background: Early and accurate assessment of traumatic injuries in pediatric patients is critical for timely diagnosis and prevention of missed associated injuries. The Pediatric Trauma Support System (PTSS) is a digital clinical decision support tool designed to integrate physiological parameters, trauma mechanism, and demographic characteristics to provide automated trauma risk assessment in children. Aim: To evaluate the clinical applicability of the Pediatric Trauma Support System (PTSS) in the primary assessment of pediatric patients with blunt trauma and to analyze the sensitivity of the Pediatric Trauma Score (PTS), particularly in children under one year of age. Materials and Methods: A prospective observational study was conducted in the Emergency Department and the Department of Pediatric Surgery at the University Hospital “St. George”, Plovdiv, Bulgaria. The study included 100 pediatric patients aged 0-18 years presenting with blunt traumatic injuries. Standard clinical evaluation was performed for all patients, including assessment of vital signs and neurological status using the Glasgow Coma Scale (GCS). PTSS was used to automatically calculate the Pediatric Trauma Score (PTS) and generate recommendations for imaging diagnostics. Twenty-five patients were under two years of age, including nine infants younger than one year (6 boys and 3 girls). Demographic and clinical variables were analyzed descriptively. Results: Among the nine patients under one year of age, all had PTS values below the normal age-adjusted threshold. In cases of mild trauma the PTS was 9/12, while in moderate trauma it was 8/12. The PTSS algorithm generated recommendations for head computed tomography (CT) and abdominal ultrasound in all infants. Head imaging was performed in all nine patients, revealing a parietal bone fracture in one 27-day-old infant. Abdominal ultrasound was not performed in clinical practice despite the algorithmic recommendation. In patients older than one year with similar trauma severity, PTS values were higher (11/12), and PTSS recommended only head CT without additional abdominal imaging. Conclusion: PTSS provides a structured and automated approach to pediatric trauma assessment by integrating PTS with clinical and demographic parameters. The system demonstrates increased sensitivity in infants under one year of age, where physiological characteristics may mask significant associated injuries. Automated recommendations for additional imaging may contribute to earlier detection of occult injuries and improved patient safety in pediatric trauma care.