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Validation of Shock Index Pediatric-Adjusted for children injured in warzones
Christopher W Marenco1, Woo S Do, Daniel T Lammers
1From the Department of Surgery (C.W.M., W.S.D., D.T.L., J.D.H., M.J.E.), Madigan Army Medical Center, Tacoma, Washington; and Department of Surgery (K.A.), Oregon Health and Science University, Doernbecher Children's Hospital, Portland, Oregon.
Insights
Pediatric-Adjusted Shock Index (SIPA) effectively predicts the need for blood transfusions and emergency surgery in pediatric warzone trauma patients. This vital tool aids in critical triage and resource allocation in austere environments.
Area of Science:
- Trauma Surgery
- Pediatric Critical Care
- Military Medicine
Background:
- Pediatric-Adjusted Shock Index (SIPA) is established for civilian pediatric trauma outcome prediction.
- Limited data exists on SIPA's utility in pediatric warzone trauma, a critical area for triage.
Purpose of the Study:
- To evaluate the efficacy of SIPA in predicting blood product transfusion and emergent surgery needs in pediatric warzone casualties.
- To assess SIPA's role in resource allocation and triage in austere combat environments.
Main Methods:
- Retrospective review of the DoD Trauma Registry (2008-2015) for pediatric patients (≤17 years).
- SIPA calculation upon arrival; classification into normal vs. elevated groups using age-specific thresholds.
- Comparison of blood product transfusion (BPT) and emergent surgical procedures (ESP) between SIPA groups; regression analysis for outcome association.
Main Results:
- Elevated SIPA was significantly associated with increased need for BPT (49.2% vs. 25.0%) and ESP (22.9% vs. 16.0%).
- Patients with elevated SIPA also showed higher ICU admission (49.9% vs. 36.1%) and mortality rates (10.3% vs. 4.8%).
- Regression analysis confirmed elevated SIPA as an independent predictor for BPT (OR 2.36) and ESP (OR 1.29).
Conclusions:
- This study is the first to examine SIPA in pediatric warzone trauma.
- Elevated SIPA is a strong predictor of increased need for blood transfusion and emergent surgery in this population.
- SIPA can serve as a valuable triage and planning tool in austere settings for pediatric war casualties.
Background:
Shock Index Pediatric-Adjusted (SIPA) has been used to predict injury severity and outcomes after civilian pediatric trauma. We hypothesize that SIPA can predict the need for blood transfusion and emergent surgery among pediatric patients injured in warzones, where resources are limited and accurate triage is essential.
Methods:
Retrospective review of the DoD Trauma Registry for all patients 17 years or younger, from 2008 to 2015. Shock Index Pediatric-Adjusted was determined using vital signs recorded upon arrival to the initial level of care. Patients were classified into two groups (normal vs. elevated SIPA) using age-specific threshold values. The need for blood product transfusion (BPT) within 24 hours and emergent surgical procedures (ESP) was compared between groups. Intensive care unit admission, injury severity, and mortality were also compared. Regression analysis was performed to evaluate the relationship between SIPA and primary outcomes.
Results:
There were 2,121 patients included with a mean Injury Severity Score of 12 ± 10. The mechanism of injury was penetrating (63%), blunt (25%), and burns (12%). Patients with an elevated SIPA (43%) had a significantly greater need for BPT (49.2% vs. 25.0%) and ESP (22.9% vs. 16.0%), as well as mortality (10.3% vs. 4.8%) and intensive care unit admission (49.9% vs. 36.1%), all p less than 0.001. Regression analysis confirmed an elevated SIPA as independently associated with both BPT (odds ratio, 2.36; 95% confidence interval, 1.19-2.94; p < 0.001) and ESP (odds ratio, 1.29; 95% confidence interval, 1.01-1.64; p = 0.044).
Conclusion:
This is the first study of SIPA in pediatric warzone trauma. Elevated SIPA is associated with significantly increased need for BPT and emergent surgery and may therefore serve as a valuable tool for planning and triage in austere settings.
Level Of Evidence:
Prognostic/epidemiological, Level III.
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