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Delta Shock Index Predicts Outcomes in Pediatric Trauma Patients Regardless of Age
Samer Asmar1, Muhammad Zeeshan2, Muhammad Khurrum1
1Division of Trauma, Critical Care, Department of Surgery, Emergency Surgery, and Burns, College of Medicine, University of Arizona, Tucson, Arizona.
Insights
Changes in the shock index (ΔSI) predict mortality in pediatric trauma patients. This vital sign change can guide emergency department triage for improved outcomes.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Clinical Prognostics
Background:
- The shock index (SI), calculated as heart rate divided by systolic blood pressure, is a recognized predictor of mortality.
- Its utility and established cutoffs are not well-defined for pediatric trauma patients.
Purpose of the Study:
- To assess the impact of the change in shock index (ΔSI) on mortality in pediatric trauma patients.
- To establish age-specific ΔSI cutoffs for predicting outcomes in children.
Main Methods:
- Analysis of 31,490 pediatric trauma patients (0-16 years) from the 2017 ACS-TQIP database.
- Calculation of ΔSI (ED SI - EMS SI) and determination of age-specific cutoffs using ROC analysis.
- Multivariable logistic and Cox regression analyses to evaluate the association between ΔSI and mortality.
Main Results:
- Overall mortality rate was 1.4%.
- Age-specific ΔSI cutoffs ranged from 0.05 to 0.41, with AUCs between 0.70 and 0.83.
- +ΔSI was independently associated with increased in-hospital and 24-hour mortality (P ≤ 0.01).
Conclusions:
- The change in shock index (ΔSI) is a validated predictor of mortality in pediatric trauma.
- ΔSI accounts for age-related variations in vital signs and can aid in triage decisions.
- Utilizing ΔSI may improve the identification and management of critically injured children.
Introduction:
Changes in the shock index (ΔSI) can be a predictive tool but is not established among pediatric trauma patients. The aim of our study was to assess the impact of ΔSI on mortality in pediatric trauma patients.
Methods:
We performed a 2017 analysis of all pediatric trauma patients (age 0-16 y) from the ACS-TQIP. SI was defined as heart rate(HR)/systolic blood pressure(SBP). We abstracted the SI in the field (EMS), SI in the emergency department (ED) and calculated the change in SI (ΔSI = ED SI-EMS SI). Patients were divided into four age groups: 0-3 y, 4-6 y, 7-12 y, and 13-16 y and substratified into two groups based on the value of the age-group-specific ΔSI cutoff obtained with receiver operating characteristic ROC analysis; +ΔSI and -ΔSI. Our outcome measure was mortality. Multivariable logistic and Cox regression analyses were performed.
Results:
We included 31,490 patients. Mean age was 10.6 ± 4.6 y, and 65.8% were male. The overall mortality rate was 1.4%. In the age group 0-3 y the cutoff point for ΔSI was 0.29 with an area under the curve (AUC) 0.70 [0.62-0.79], ΔSI cutoff 4-6 y was 0.41 AUC 0.81 [0.70-0.92], ΔSI cutoff 7-12 y was 0.05 AUC 0.83 [0.76-0.90], and ΔSI cutoff 13-16 y was 0.13 AUC 0.75 [0.69-0.81]. On the Cox regression analysis, +ΔSI was independently associated with increased in-hospital mortality and 24-h mortality (P ≤ 0.01).
Conclusions:
Vital signs vary by age group in children, but ΔSI inherently accounts for this variation. ΔSI predicts mortality and may be utilized as a predictor to help guide triage of pediatric trauma patients.
Level Of Evidence:
Level III Prognostic.
