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Addition of neurological status to pediatric adjusted shock index to predict early mortality in trauma: A pediatric
Daniel T Lammers1, Christopher W Marenco, Kaitlin R Morte
1From the Department of General Surgery (D.T.L., C.W.M., K.R.M., J.R.C., J.D.H., J.R.B., M.J.E.), Madigan Army Medical Center; Department of Pediatric Surgery (M.B., M.A.E.), Mary Bridge Children's Hospital, Tacoma, Washington; Department of Trauma and Acute Care Surgery (M.J.M.), Scripps Mercy Hospital, San Diego, California; and Department of Surgery (M.J.E.), University of North Carolina, Chapel Hill, North Carolina.
Introduction:
Pediatric adjusted shock index (SIPA) has demonstrated the ability to prospectively identify children at the highest risk for early mortality. The addition of neurological status to shock index has shown promise as a reliable triage tool in adult trauma populations. This study sought to assess the utility of combining SIPA with Glasgow Coma Scale (GCS) for predicting early trauma-related outcomes.
Methods:
Retrospective review of the 2017 Trauma Quality Improvement Program Database was performed for all severely injured patients younger than 18 years old. Pediatric adjusted shock index and reverse SIPA × GCS (rSIG) were calculated. Age-specific cutoff values were derived for reverse shock index multiplied by GCS (rSIG) and compared with their SIPA counterparts for early mortality assessment using area under the receiver operating characteristic curve analyses.
Results:
A total of 10,389 pediatric patients with an average age of 11.4 years, 67% male, average Injury Severity Score of 24.1, and 4% sustaining a major penetrating injury were included in the analysis. The overall mortality was 9.3%. Furthermore, 32.1% of patients displayed an elevated SIPA score, while only 27.5% displayed a positive rSIG. On area under the receiver operating characteristic curve analysis, rSIG was found to be superior to SIPA as a predictor for in hospital mortality with values of 0.854 versus 0.628, respectively.
Conclusion:
Reverse shock index multiplied by GCS more readily predicted in hospital mortality for pediatric trauma patients when compared with SIPA. These findings suggest that neurological status should be an important factor during initial patient assessment. Further study to assess the applicability of rSIG for expanded trauma-related outcomes in pediatric trauma is necessary.
Level Of Evidence:
Prognostic study, level IV.
