Validation of the age-adjusted shock index using pediatric trauma quality improvement program data

Area of Science:

• Pediatric Trauma Care
• Emergency Medicine
• Clinical Prognostics

Background:

• The standard shock index (SI) (heart rate/systolic blood pressure) is a known predictor of injury severity in adult trauma.
• The age-adjusted shock index (SIPA) has shown promise in pediatric blunt trauma patients aged 4-16 years.
• The utility of SI and SIPA in younger children (1-4 years) and for penetrating trauma remains less understood.

Purpose of the Study:

• To confirm the superiority of SIPA over SI in pediatric blunt trauma.
• To expand the validation of SIPA to include pediatric penetrating trauma.
• To evaluate SIPA's effectiveness in younger children aged 1-4 years.

Main Methods:

• Developed age-specific cutoff values for SIPA in children aged 1-3 years.
• Utilized the 2014 Pediatric Trauma Quality Improvement Program (TQIP) database for patients aged 1-16 years with blunt or penetrating trauma.
• Compared SI and SIPA in predicting injury severity, transfusion needs, ICU admission, ventilator use, and mortality.

Main Results:

• SIPA was elevated in 15.6% of blunt and 19.4% of penetrating trauma cases, compared to 41.3% and 40.0% for SI, respectively.
• SIPA demonstrated significantly better prediction of transfusion needs, injury severity, ICU admission, ventilator use, and mortality for both trauma types.
• The study analyzed 22,344 blunt and 613 penetrating trauma patients.

Conclusions:

• SIPA is a more effective tool than SI for identifying severe injury and predicting outcomes in pediatric blunt and penetrating trauma.
• SIPA's improved predictive capability extends to transfusion needs and mortality.
• Further research is recommended to explore SIPA's potential as a pediatric trauma triage tool.