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

Age, degree of injury, different metabolic rates, and growth complicat e the estimation of nutritional requirements in the pediatric trauma v ictim. This study was designed to determine energy require- ments of t he injured child in relation to injury severity. Fourteen patients of 600 seen in a 5-year period met our criteria for evaluation with signi ficant weight loss, caloric deficit recorded to the lowest weight, and details of injury. There were 10 males and four females with a mean a ge 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 Calor ic 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 R ecommended Dietary Allowances (RDA) (mean -16.43+/-4%). The per cent i ncrease 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 consi stent with the child with milder injuries resuming activity and the gr owth 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).