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Dynamic trend or static variable: Shock Index Pediatric-Adjusted (SIPA) in warzone trauma
Christopher W Marenco1, Daniel T Lammers1, Woo S Do1
1Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA.
Insights
Trends in the Shock Index Pediatric Adjusted (SIPA) can predict outcomes in pediatric warzone trauma. Persistently abnormal SIPA values indicate worse outcomes, including severe injury and mortality.
Area of Science:
- Pediatric trauma care
- Military medicine
- Physiological monitoring
Background:
- Civilian studies indicate Shock Index Pediatric Adjusted (SIPA) trends predict trauma outcomes.
- Pediatric warzone trauma presents unique challenges in outcome prediction.
- SIPA is a potentially valuable tool for assessing pediatric trauma severity.
Purpose of the Study:
- To evaluate the association between SIPA trends and outcomes in pediatric warzone trauma patients.
- To determine if SIPA can serve as a predictive biomarker in this specific population.
- To compare outcomes based on different SIPA trend patterns.
Main Methods:
- Retrospective review of the Department of Defense Trauma Registry (2008-2015).
- Inclusion of pediatric patients (age ≤17 years) with trauma.
- Classification of SIPA trends (normal-normal, normal-abnormal, abnormal-normal, abnormal-abnormal) and comparison of outcomes (ICU admission, severe injury, mechanical ventilation, mortality).
Main Results:
- 669 pediatric patients were analyzed, with blast injuries being most common (46.5%).
- Patients with persistently abnormal SIPA (Group 4) showed significantly higher rates of severe injury, ICU admission, mechanical ventilation, and mortality.
- Different SIPA trend groups had varying incidences of adverse outcomes.
Conclusions:
- Trends in SIPA are a significant predictor of outcomes in pediatric warzone trauma.
- Persistently abnormal SIPA values are strongly associated with poorer patient outcomes.
- SIPA monitoring offers a potential method for early risk stratification in pediatric warzone casualties.
Background:
Civilian studies suggest that trending Shock-Index Pediatric Adjusted(SIPA) values can prove useful in the prediction of trauma outcomes. The purpose of this study was to evaluate the relationship between trends in SIPA and outcomes in pediatric warzone trauma.
Methods:
Retrospective review of the Department of Defense Trauma Registry from 2008 to 2015, including all patients age ≤17years. SIPA was calculated both pre-hospital and upon arrival, then classified as "normal" or "abnormal" based upon previously validated thresholds. Patients were stratified into groups based on the trend of their SIPA (1-normal to normal, 2-normal to abnormal, 3-abnormal to normal, 4-abnormal to abnormal). Key outcomes including ICU admission, severe injury, mechanical ventilation, and mortality were then compared between groups.
Results:
669 patients were included, mean ISS 12 ± 10. The most common mechanism of injury was blast (46.5%). Overall, 43% were stratified into Group 1, 13.9% into Group 2, 14.8% into Group 3, and 28.0% into Group 4. Those patients with a persistently abnormal SIPA (Group 4) had significantly increased incidence of severe injury, ICU admission, need for mechanical ventilation, and mortality.
Conclusion:
Trends in SIPA may be used to predict trauma outcomes for children injured in warzones, with persistently abnormal values associated with worse outcomes overall.
