Related Experiment Video
Updated: Feb 26, 2026
Description of a Swine Infant Model of Volume-Controlled Hemorrhagic Shock
Published on: November 3, 2023
Interfacility Transport Shock Index Is Associated With Decreased Survival in Children
Ryan M Jennings1, Bradley A Kuch2, Kathryn A Felmet3
1From the University of Pittsburgh School of Medicine.
Insights
The shock index, a vital sign ratio, helps identify sepsis in children during transport. However, it did not predict survival to hospital discharge in this pediatric study.
Area of Science:
- Pediatric critical care medicine
- Emergency medicine
- Clinical diagnostics
Background:
- The shock index (SI), heart rate divided by systolic blood pressure, is linked to mortality in adult trauma and pediatric sepsis.
- Its utility in predicting sepsis diagnosis and survival in pediatric interfacility transport is not well-established.
Purpose of the Study:
- To evaluate the shock index's effectiveness in diagnosing sepsis and predicting survival in children during interfacility transport to a tertiary care center.
Main Methods:
- A retrospective study of 3519 children (1 month to 21 years) undergoing interfacility transport.
- Children were stratified into four age groups and categorized by sepsis diagnosis (ICD-9).
- Vital signs, including initial shock index, were recorded; primary outcome was survival to hospital discharge.
Main Results:
- Sepsis was diagnosed in 14% of children. The initial shock index decreased significantly with age (P < 0.001).
- Elevated initial shock index was associated with sepsis diagnosis across all age groups (P < 0.05).
- While showing a trend for survival in univariate analysis (P = 0.05), the shock index was not a predictor in multivariable analysis. Higher SI quartiles correlated with ICU admission.
Conclusions:
- An elevated shock index in pediatric patients during interfacility transport is associated with a sepsis diagnosis.
- The shock index did not predict hospital survival in this cohort but was linked to ICU admission.
Background:
Shock index, the ratio of heart rate to systolic blood pressure that changes with age, is associated with mortality in adults after trauma and in children with sepsis. We assessed the utility of shock index to predict sepsis diagnosis and survival in children requiring interfacility transport to a tertiary care center.
Methods:
We studied children aged 1 month to 21 years who had at least 2 sets of vital signs recorded during interfacility transport to the Children's Hospital of Pittsburgh by our critical care transport team. Subjects were divided into 4 age groups: group 1 (<1 year), group 2 (1-3 years), group 3 (4-11 years), and group 4 (≥12 years). Children were also grouped into sepsis or nonsepsis group based on the International Classification of Diseases, Ninth Revision categories. Primary outcome was survival to hospital discharge.
Results:
Of 3519 children studied, 493 (14%) had sepsis. Initial shock index decreased with increasing age: group 1, 1.45 ± 0.42 (mean ± SD); group 2, 1.35 ± 0.32; group 3, 1.20 ± 0.34; and group 4, 1.00 ± 0.32 (P < 0.001). Initial shock index was increased in children with sepsis versus those with no sepsis overall and in all age groups (all P < 0.05). Initial shock index showed a trend for association with survival in univariate analysis (P = 0.05) but was not associated with survival in a multivariable logistic regression. Highest quartile of shock index was associated with need for intensive care unit admission posttransport.
Conclusions:
Increased shock index in children requiring intrafacility transport was associated with hospital discharge diagnosis of sepsis but not hospital survival.
