Utilization of age-adjusted shock index in a resource-strained setting

Area of Science:

• Trauma care and critical illness in pediatrics.
• Application of physiological indices in resource-limited settings.

Background:

• Accurate identification of injury severity and triage are crucial for effective surgical care, particularly in resource-strained environments.
• Traditional shock index (SI) may have limitations in assessing pediatric trauma patients, especially in middle-income countries (MICs).

Purpose of the Study:

• To evaluate the effectiveness of pediatric age-adjusted shock index (SIPA) compared to traditional shock index (SI) in identifying injury severity and predicting outcomes in pediatric trauma patients.
• To assess the utility of SIPA in a middle-income country (MIC) setting with strained medical and surgical resources.

Main Methods:

• Retrospective review of injured children hospitalized in trauma centers in South Africa (MIC) and the United States (high-income country) from 2012 to 2017.
• Shock Index (SI) calculated using maximum heart rate and minimum systolic blood pressure. SI elevation defined as >0.9.
• Pediatric Age-Adjusted Shock Index (SIPA) elevation defined by age-stratified SI thresholds (1-6 years: >1.22, 7-12 years: >1.0, 13-17 years: >0.9). Comparison via univariate analyses and AUROC.

Main Results:

• A total of 1648 pediatric patients were analyzed (741 MIC, 907 high-income country).
• Elevated SIPA was more strongly associated with Injury Severity Score (ISS) ≥25, ICU admission, and mortality in both HIC and MIC settings.
• In MIC patients, elevated SIPA significantly improved discrimination for in-hospital mortality (AUROC 0.66 vs. 0.57, p < 0.01).

Conclusions:

• SIPA effectively identifies injured children with altered physiology, greater injury severity, and poorer outcomes in a multinational cohort including MIC patients.
• The use of SIPA shows potential for enhancing resource utilization and improving triage effectiveness in middle-income countries.