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Pediatric specific shock index accurately identifies severely injured children
Shannon N Acker1, James T Ross1, David A Partrick1
1Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO USA.
Insights
A new age-adjusted shock index (SIPA) in pediatric trauma patients is more effective than the standard shock index (SI) for identifying severe injuries and predicting mortality. SIPA improves the accuracy of outcome prediction in children following blunt trauma.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Clinical Outcomes Research
Background:
- The standard shock index (SI), calculated as heart rate divided by systolic blood pressure, is a known predictor of mortality in adult trauma patients.
- The efficacy of the unadjusted SI in predicting outcomes for pediatric trauma patients remains less clear.
Purpose of the Study:
- To evaluate the hypothesis that an age-adjusted shock index could more accurately predict outcomes in children compared to the standard SI.
- To assess the predictive capability of the pediatric age-adjusted shock index (SIPA) for severe injury and mortality in pediatric trauma.
Main Methods:
- A retrospective review was conducted on 543 pediatric patients (ages 4-16) admitted to two trauma centers following blunt trauma with an Injury Severity Score (ISS) > 15.
- The study compared the predictive accuracy of the standard SI (>0.9) with the age-adjusted SIPA, which utilizes age-specific normal heart rate and systolic blood pressure values.
Main Results:
- The age-adjusted SIPA identified a lower percentage of children with abnormal values (28%) compared to the standard SI (50%).
- SIPA demonstrated improved discrimination for severe injury (ISS > 30), need for blood transfusion, severe liver/spleen lacerations, and in-hospital mortality compared to the standard SI.
Conclusions:
- The pediatric-specific shock index (SIPA) is a more accurate tool for identifying severely injured children.
- SIPA improves the prediction of intra-abdominal injuries requiring transfusion and identifies pediatric patients at higher risk of death.
Introduction:
Shock index (SI) (heart rate/systolic blood pressure)>0.9 predicts mortality in adult trauma patients. We hypothesized that age adjusted SI could more accurately predict outcomes in children.
Methods:
Retrospective review of children age 4-16 years admitted to two trauma centers between 1/07 and 6/13 following blunt trauma with an injury severity score (ISS)>15 was performed. We evaluated the ability of SI>0.9 at emergency department presentation and elevated shock index, pediatric age adjusted (SIPA) to predict outcomes. SIPA was defined by maximum normal HR and minimum normal SBP by age. Cutoffs included SI>1.22 (age 4-6), >1.0 (7-12), and >0.9 (13-16).
Results:
Among 543 children, 50% of children had an SI>0.9 but this fell to 28% using age adjusted SI (SIPA). SIPA demonstrated improved discrimination of severe injury relative to SI: ISS>30: 37% vs 26%; blood transfusion within the first 24 hours: 27% vs 20%; Grade III liver/spleen laceration requiring blood transfusion: 41% vs 26%; and in-hospital mortality: 11% vs 7%.
Conclusion:
A pediatric specific shock index (SIPA) more accurately identifies children who are most severely injured, have intraabdominal injury requiring transfusion, and are at highest risk of death when compared to shock index unadjusted for age.
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