Elevated pediatric age-adjusted shock-index (SIPA) in blunt solid organ injuries

Area of Science:

• Pediatric Surgery
• Trauma Surgery
• Pediatric Critical Care

Background:

• The pediatric age-adjusted shock index (SIPA) is established for predicting outcomes in pediatric blunt trauma.
• Early identification of children with blunt liver or spleen injury (BLSI) is crucial for appropriate management.

Purpose of the Study:

• To investigate if an elevated SIPA score in pre-hospital or emergency department (ED) settings can identify children with BLSI.
• To determine if elevated SIPA is associated with the need for blood transfusion or failure of non-operative management (NOM).

Main Methods:

• Retrospective analysis of pediatric patients (1-18 years) with BLSI from the ACS pediatric-TQIP database (2014-2016).
• Patients were stratified based on the requirement for blood transfusion and/or abdominal operation.
• Multivariable regression was used to assess the association between SIPA and clinical outcomes.

Main Results:

• A total of 3561 patients with BLSI were analyzed; 4% received blood transfusions and 4% underwent surgery.
• Patients needing blood transfusion or failing NOM had significantly higher Injury Severity Scores (ISS) and mortality.
• An elevated pre-hospital or ED SIPA was strongly associated with the need for blood transfusion (OR 8.2) and failure of NOM (OR 2.3).

Conclusions:

• Elevated SIPA in pre-hospital or ED settings is a reliable indicator of hemodynamic instability in children with BLSI.
• SIPA effectively identifies pediatric patients with BLSI who are at higher risk for requiring blood products or surgical intervention.
• This tool can aid clinicians in early risk stratification and management decisions for pediatric blunt abdominal trauma.