There are currently several injury severity scores, such as the LSI, MESI, MESS, and PSI that are used in the United States to form recommendations for limb amputation or reconstruction. These scores are based on data from adults, yet they are used for patients of all ages. Because parents with limited health literacy tend to make less informed medical decisions for their children regarding amputations, a pediatric version of a current injury severity score would help to guide these medical decisions. The pediatric version would be created from a pre-existing score by redesigning the variables used within the score. The Predictive Salvage Index (PSI) was the most viable score for pediatric use. This was due to its levels of sensitivity, specificity, and its simplicity when compared to other scores such as the Mangled Extremity Severity Score (MESS) and Mangled Extremity Score Index (MESI). After examining data based on children that correlated with the variables used in the PSI (level of arterial injury, degree of bone injury, degree of muscle injury, and interval of time from injury to operating table), suggestions were made to shift the amount of points patients were assigned by the PSI, creating a more accurate recommendation for pediatric patients. Using this pediatric version of the PSI, a decision-making protocol could then be implemented into health care systems as a way to help parents when making medical decisions for their children regarding amputations. Since one in four parents are found to have limited health literacy of some kind in the United States, this protocol is recommended to address low health literacy.
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