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Shock Index Values and Trends in Pediatric Sepsis: Predictors or Therapeutic Targets? A Retrospective Observational

Samiran Ray1, Mirjana Cvetkovic, Joe Brierley

  • 1*Children's Acute Transport Service, Great Ormond Street Hospital NHS Trust, London, UK †University Hospitals of Leicester NHS Trusts, Leicester, UK ‡Addenbrookes Hospital NHS Trust, Cambridge, UK §Imperial College Healthcare NHS Trust, London, UK ¶University College London Institute of Child Health, London, UK.

Shock (Augusta, Ga.)
|May 21, 2016
PubMed

Insights

The shock index (SI) does not better predict early death in pediatric sepsis than heart rate or blood pressure alone. Changes in SI also showed no improved predictive value for mortality in critically ill children.

Area of Science:

  • Pediatric critical care medicine
  • Sepsis research
  • Hemodynamic monitoring

Background:

  • Shock index (SI), calculated as heart rate (HR)/systolic blood pressure (SBP), is used to predict outcomes in adult and pediatric sepsis.
  • The utility of SI for predicting outcomes before pediatric intensive care unit (PICU) admission requires further evaluation.

Purpose of the Study:

  • To assess the predictive value of SI before PICU admission for early mortality in pediatric sepsis.
  • To compare the predictive capabilities of SI with individual HR and SBP measurements.

Main Methods:

  • Retrospective observational study of children referred to a pediatric intensive care transport service (PICTS) from 2005-2011.
  • Evaluated SI, HR, and SBP at referral, PICTS arrival, and PICU admission, as well as changes in SI.
  • Primary outcome was death within 48 hours of ICU admission.

Main Results:

  • SI was significantly higher in children who died early.
  • Survivors showed significant improvement in SI with transport team intervention, while nonsurvivors did not.
  • The predictive value of a change in SI for mortality was not superior to changes in HR or SBP.

Conclusions:

  • Absolute SI or changes in SI do not offer superior prediction of early death in pediatric sepsis compared to individual HR and SBP.
  • Clinical utility of SI for pre-PICU prediction of mortality in pediatric sepsis is limited.
Abstract

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