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Shock Index as a Predictor of Morbidity and Mortality in Pediatric Trauma Patients
Jonathan Strutt1, Andrew Flood2, Anupam B Kharbanda1
1From the Departments of Pediatric Emergency Medicine and.
Insights
Age-adjusted shock index (SI) accurately predicts negative outcomes in pediatric trauma patients. An elevated SI is the strongest predictor of mortality, outperforming hypotension or tachycardia alone.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Critical Care
Background:
- The unadjusted shock index (SI) is a ratio of heart rate to systolic blood pressure.
- Age-adjusted SI has shown promise in identifying negative outcomes in pediatric injury patients.
Purpose of the Study:
- To evaluate the utility of age-adjusted SI in predicting negative outcomes in pediatric trauma.
- To compare the predictive power of age-adjusted SI against other clinical indicators.
Main Methods:
- Analysis of pediatric patients (<15 years) from the National Trauma Data Bank.
- Definition of elevated SI based on age-specific high-normal heart rate and low-normal blood pressure.
- Primary outcome: mortality; Secondary outcomes: blood transfusion, ventilation, procedures, ICU stay.
Main Results:
- Overall mortality rate was 0.7% in 28,741 pediatric trauma cases.
- Elevated SI (1.7% of cases) was strongly associated with increased need for blood transfusion, ventilation, procedures, and ICU stay (P < 0.001).
- Elevated SI was the strongest predictor of mortality (OR 22.0), surpassing hypotension (OR 12.6) and tachycardia (OR 2.6).
Conclusions:
- Elevated age-adjusted SI is a specific and accurate predictor of morbidity and mortality in pediatric trauma.
- Age-adjusted SI is superior to using tachycardia or hypotension alone for predicting mortality in this population.
Objectives:
Compared with unadjusted shock index (SI) (heart rate/systolic blood pressure), age-adjusted SI improves identification of negative outcomes after injury in pediatric patients. We aimed to further evaluate the utility of age-adjusted SI to predict negative outcomes in pediatric trauma.
Methods:
We performed an analysis of patients younger than 15 years using the National Trauma Data Bank. Elevated SI was defined as high normal heart rate divided by low-normal blood pressure for age. Our primary outcome measure was mortality. Secondary outcomes included need for a blood transfusion, ventilation, any operating room/interventional radiology procedures, and intensive care unit stay. Multiple logistic regressions were performed.
Results:
Twenty-eight thousand seven hundred forty-one cases met the study criteria. The overall mortality rate was 0.7%, and 1.7% had an elevated SI. Patients with an elevated SI were more likely (P < 0.001) to require blood transfusion, ventilation, an operating room/interventional radiology procedure, or an intensive care unit stay. An elevated SI was the strongest predictor for mortality (odds ratio [OR] 22.0) in pediatric trauma patients compared with hypotension (OR, 12.6) and tachycardia (OR, 2.6).
Conclusions:
Elevated SI is an accurate and specific predictor of morbidity and mortality in pediatric trauma patients and is superior to tachycardia or hypotension alone for predicting mortality.
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