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Standardized Hemorrhagic Shock Induction Guided by Cerebral Oximetry and Extended Hemodynamic Monitoring in Pigs
Published on: May 21, 2019
A pediatric specific shock index in combination with GMS identifies children with life threatening or severe
Shannon N Acker1, James T Ross2, David A Partrick3
1Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA. shannon.acker@ucdenver.edu.
Insights
The shock index, pediatric age adjusted (SIPA) or abnormal Glasgow Coma Scale motor score (GMS) better identifies severe traumatic brain injury (TBI) in children than hypotension alone. This combination offers higher sensitivity for detecting severe TBI in pediatric blunt trauma cases.
Area of Science:
- Pediatric emergency medicine
- Trauma surgery
- Neurocritical care
Background:
- The shock index, pediatric age adjusted (SIPA) has previously shown efficacy in identifying severely blunt injured children.
- Accurate identification of severe traumatic brain injury (TBI) in pediatric blunt trauma is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To evaluate if SIPA is more accurate than hypotension in identifying severe TBI in children.
- To compare the sensitivity of SIPA, hypotension, abnormal GCS motor score (GMS), and their combinations in identifying severe pediatric TBI.
Main Methods:
- Subset analysis of children aged 4-16 years with blunt trauma and Injury Severity Score ≥15.
- Evaluation of four markers: hypotension, elevated SIPA, abnormal GMS, and elevated SIPA or abnormal GMS.
- Comparison of marker sensitivity in identifying severely brain-injured children.
Main Results:
- 392 children were analyzed. Hypotension was present in 6%, elevated SIPA in 27%, abnormal GMS in 44%, and elevated SIPA or abnormal GMS in 53%.
- All evaluated markers identified severely injured children with TBI.
- The combination of elevated SIPA or abnormal GMS demonstrated higher sensitivity in identifying complications compared to other markers.
Conclusions:
- Elevated SIPA or abnormal GMS is effective in identifying severely brain-injured children with TBI.
- The combined marker (SIPA or abnormal GMS) offers superior sensitivity for detecting severe TBI in pediatric blunt trauma patients.
Purpose:
We have previously demonstrated that a shock index, pediatric age adjusted (SIPA) accurately identifies severely blunt injured children. We aimed to determine if SIPA could more accurately identify children with severe traumatic brain injury (TBI) than hypotension alone.
Methods:
We performed subset analysis of those children with TBI among a cohort of children age 4-16 years with blunt trauma and injury severity score ≥15 from 1/07 to 6/13. We evaluated the ability of four markers to identify the most severely brain injured children. Markers included hypotension, elevated SIPA, abnormal GCS motor score (GMS), and elevated SIPA or abnormal GMS. We aimed to determine which of these four markers had the highest sensitivity in identifying severely injured children.
Results:
Three hundred and ninety-two (392) children were included. Hypotension was present in 24 patients (6%); elevated SIPA in 106 (27 %), abnormal GMS in 172 (44%), and elevated SIPA or abnormal GMS in 206 (53%). All markers were able to accurately identify severely injured children with TBI. Elevated SIPA or abnormal GMS identified a greater percentage of patients with each of seven complications with higher sensitivity than each of the three other markers.
Conclusion:
Among blunt injured children with TBI, elevated SIPA or abnormal GMS identifies severely brain injured children.
