Related Experiment Video
Updated: Dec 30, 2025
Description of a Swine Infant Model of Volume-Controlled Hemorrhagic Shock
Published on: November 3, 2023
Comparison of Prehospital Calculated Age-Adjusted Pediatric Shock Index (SIPA) to Those Calculated in the ED for
Insights
Prehospital vital signs can calculate the pediatric age-adjusted shock index (SIPA) score, which is comparable to the trauma bay SIPA in identifying critically ill children. Both measures demonstrate high specificity for trauma triage.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care
- Critical Care
Background:
- The shock index (SI) is the ratio of heart rate to systolic blood pressure.
- A pediatric age-adjusted SI (SIPA) is more specific than the adult SI for identifying critically ill children in trauma settings.
- Utilizing prehospital vital signs for SIPA calculation could aid in early identification of critically injured pediatric patients.
Purpose of the Study:
- To calculate the pediatric age-adjusted shock index (SIPA) using prehospital vital signs.
- To compare prehospital SIPA (EMS SIPA) with trauma bay SIPA (ED SIPA) in identifying critically ill children.
- To assess the validity of EMS SIPA in comparison to ED SIPA against consensus-based trauma activation criteria.
Main Methods:
- Retrospective study of 2651 pediatric patients (ages 1-16) transferred to a level one pediatric trauma center (2016-2017).
- EMS SIPA calculated from vital signs during the EMS patch call.
- ED SIPA calculated from the first set of vital signs obtained in the trauma bay.
Main Results:
- Elevated EMS SIPA in 20.6% and elevated ED SIPA in 16.5% of patients.
- Both EMS and ED SIPA identified patients meeting consensus criteria, except for interventional radiology (IR) intervention and unstable spinal injuries, where ED SIPA performed better.
- Both measures showed poor sensitivity but high specificity, with a poor positive predictive value (PPV) and high negative predictive value (NPV).
Conclusions:
- Prehospital SIPA calculation using EMS vital signs is comparable to ED SIPA in identifying critically ill pediatric trauma patients.
- Both EMS and ED SIPA demonstrate high specificity, suggesting their utility in trauma triage.
- Further research may refine SIPA's role in identifying specific critical injuries like those requiring IR intervention or unstable spinal trauma.
Abstract:
Background: The shock index (SI) is defined as the ratio of the heart rate to systolic blood pressure and a pediatric age-adjusted SI (SIPA) is more specific than the standard adult cutoff of 0.9 in identifying the sickest children presenting to a trauma center.Goal: To utilize prehospital vital signs to calculate the SIPA score and compare them to the SIPA calculated in the trauma bay to determine if they have the same validity in identifying critically ill children as determined by the consensus based standard criteria for trauma activation.Methods: Retrospective study using a cohort of patients transferred by EMS to a free standing, urban, level one, pediatric trauma center aged 1 to 16 years inclusive, and seen between January 1, 2016 and December 31, 2017. Vital signs collected during the patch call from the EMS agency were used to calculate the EMS SIPA. The first set of vital signs collected in the trauma bay was used to calculate the ED SIPA. Patients were dichotomized to an elevated or non-elevated ED SIPA and an elevated or non-elevated EMS SIPA.Results: Our cohort consisted of 2651 patients. 546 (20.6%) patients had an elevated EMS SIPA and 438 (16.5%) had an elevated ED SIPA. When compared to their non-elevated counterparts, EMS and ED SIPA were both able to identify patients who met consensus criteria in all areas except the need for IR intervention, and unstable spinal fracture/spinal cord injury. For these criteria, the ED SIPA was better than the EMS SIPA. Sensitivity and specificity analysis reveal poor sensitivity for both measures but a high specificity for ED and EMS SIPA. Both SI and SIPA have a poor PPV but high NPV.Conclusions: This study utilized prehospital vital signs to calculate the SIPA score and compare them to the SIPA calculated in the trauma bay. Both scores had similar test metrics when based on the consensus based standard trauma criteria and could be utilized in the triage traumatic injuries.
Related Concept Videos
01:23Cardiopulmonary Resuscitation III: AED Use
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:24Blood Pressure Imbalances and Circulatory Shock
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...