INJURY SEVERITY SCORE AS A GUIDE TO NUTRITIONAL MANAGEMENT OF THE PEDIATRIC TRAUMA PATIENT

Age, degree of injury, different metabolic rates, and growth complicate the estimation of nutritional requirements in the pediatric trauma victim. This study was designed to determine energy require- ments of the injured child in relation to injury severity. Fourteen patients of 600 seen in a 5-year period met our criteria for evaluation with significant weight loss, caloric deficit recorded to the lowest weight, and details of injury. There were 10 males and four females with a mean age of 11.24 years (+/-5.5). Mean injury scores included ISS 24.24+/-5.96, PTS 4.8+/-1.7, and TSS 11.79+/-2.78. The closest Theoretical Caloric Requirement (ThCR) that would have produced the Cumulative Caloric Deficit was calculated from the actual weight loss and Caloric Intake. Eighty-six per cent of the ThCR were less than or equal to the 1989 Recommended Dietary Allowances (RDA) (mean -16.43+/-4%). The per cent increase of the ThCR above the basal was significantly higher for lower ISS scores (P<0.05). When compared to RDA, the per cent change of the ThCR for mild injuries were 1.8+/-27.9% above the RDA and were 26.5+/-17.2% below the RDA for the severe injuries. These findings are consistent with the child with milder injuries resuming activity and the growth process earlier than a severely injured child. We would recommend calculating caloric requirements based on the RDA for milder injuries and on 0.75 RDA for the more severely injured child (ISS>25).