Shock index, pediatric age-adjusted (SIPA) is more accurate than age-adjusted hypotension for trauma team activation

Area of Science:

• Pediatric Trauma Care
• Emergency Medicine
• Injury Severity Assessment

Background:

• Previous research established the shock index, pediatric age-adjusted (sIPA) for identifying severely injured children post-blunt trauma.
• The study aimed to compare sIPA's accuracy against age-adjusted hypotension in predicting critical trauma team activation.

Purpose of the Study:

• To evaluate if an elevated sIPA is a more accurate predictor of highest trauma team activation in pediatric blunt trauma than age-adjusted hypotension.
• To determine the predictive value of sIPA for emergency operations, endotracheal intubation, and blood transfusions within 24 hours.

Main Methods:

• A retrospective review of 559 children (ages 4-16) with injury severity scores ≥15 after blunt trauma.
• Defined trauma team activation criteria: emergency operation, endotracheal intubation, or blood transfusion within 24 hours.
• Compared sIPA cutoffs (e.g., >1.22 for ages 4-6) with age-adjusted hypotension criteria (e.g., SBP <90 for ages 4-6).

Main Results:

• An elevated sIPA was significantly more likely to predict the need for operation (30%), endotracheal intubation (40%), and blood transfusion (53%) compared to hypotension.
• Hypotension alone poorly predicted these interventions (13-22%).
• Among children requiring all three interventions, 60% had an elevated sIPA versus only 12% who were hypotensive.

Conclusions:

• The shock index, pediatric age-adjusted is a superior predictor compared to age-adjusted hypotension for identifying pediatric blunt trauma patients requiring urgent interventions.
• Elevated sIPA accurately identifies children likely to need emergency operations, endotracheal intubation, or early blood transfusion.