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Pediatric age-adjusted shock index as a tool for predicting outcomes in children with or without traumatic brain
Marina L Reppucci1, Ryan Phillips, Maxene Meier
1From the Pediatric Surgery (M.L.R., R.P., S.N.A., J.S., S.L.M., D.B.), Children's Hospital Colorado; Division of Pediatric Surgery, Department of Surgery (M.L.R., R.P., S.N.A., J.S., S.L.M., D.B.), University of Colorado School of Medicine; The Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery (M.M.), University of Colorado School of Medicine, Aurora; and Department of Surgery (D.B.), Denver Health Medical Center, Denver, Colorado.
Insights
The pediatric age-adjusted shock index combined with traumatic brain injury (TBI) better identifies severely injured children needing early blood transfusions or at risk of death. This combined index (SIPAB+) improves triage for pediatric trauma patients with TBI.
Area of Science:
- Pediatric Trauma Care
- Triage Tools
- Injury Severity Assessment
Background:
- Pediatric age-adjusted shock index (SIPA) identifies severe pediatric trauma but excludes neurological status.
- Traumatic brain injury (TBI) is common in pediatric trauma, impacting the generalizability of SIPA.
- The study investigated if combining SIPA with TBI (SIPAB+) improves identification of severely injured children.
Purpose of the Study:
- To evaluate the accuracy of SIPA combined with TBI (SIPAB+) in identifying severely injured pediatric trauma patients.
- To assess if SIPAB+ is a better predictor of early blood transfusion and mortality compared to SIPA alone.
- To determine the utility of SIPAB+ in patients with isolated TBI and those with multisystem injuries.
Main Methods:
- Utilized data from the American College of Surgeons Pediatric Trauma Quality Improvement Program (2014-2017).
- Included pediatric patients (1-18 years) with elevated SIPA upon arrival.
- Defined SIPAB+ as elevated SIPA with Glasgow Coma Scale (GCS) ≤8 and SIPAB- as elevated SIPA with GCS >9. Performed subanalysis for isolated TBI and multisystem injuries.
Main Results:
- Out of 25,068 patients with elevated SIPA, 12.3% were classified as SIPAB+.
- SIPAB+ patients showed significantly higher rates of early blood transfusion and mortality.
- Logistic regression confirmed higher odds of early blood transfusion and mortality in SIPAB+ patients, consistent in subanalyses.
Conclusions:
- SIPAB+ accurately identifies pediatric trauma patients with TBI at high risk for early blood transfusion and/or death.
- This combined index is useful for predicting outcomes in TBI patients with elevated SIPA, regardless of concomitant injuries.
- Incorporating SIPAB+ as a triage tool can improve resource prediction for this vulnerable population.
Background:
The pediatric age-adjusted shock index (SIPA) accurately identifies severely injured children following trauma without accounting for neurological status. Understanding how the presence of traumatic brain injury (TBI) affects the generalizability of SIPA as a bedside triage tool is important given high rates of TBI in the pediatric trauma population. We hypothesized that SIPA combined with TBI (SIPAB+) would more accurately identify severely injured children.
Methods:
Patients (1-18 years old) in the American College of Surgeons Pediatric Trauma Quality Improvement Program database (2014-2017) with an elevated SIPA upon arrival to a pediatric trauma center were included. Pediatric age-adjusted shock index combined with TBI was defined as elevated SIPA with Glasgow Coma Scale score of ≤8. Pediatric age-adjusted shock index without TBI (SIPAB-) was defined as elevated SIPA with Glasgow Coma Scale score of >9. Patients were stratified into SIPAB+ and SIPAB-. A subanalysis of patients with isolated brain injury and those with brain injury and multisystem injuries was also performed. Data were compared through univariate models and three separate logistic regression models.
Results:
Overall, 25,068 had an elevated SIPA, with 12.3% classified as SIPAB+ and the remainder SIPAB-. Patients classified as SIPAB+ received more blood transfusions within 4 hours of injury and had higher mortality rates. On logistic regression, SIPAB+ patients had significantly higher odds of early blood transfusion and a combination of both. Mortality and early blood transfusion were also higher in SIPAB+ patients on subanalysis for patients with isolated TBI and those with multisystem injuries.
Conclusion:
The use of SIPAB+ as a bedside triage tool accurately identifies traumatically injured children at high risk for early blood transfusion and/or death while incorporating the presence of neurological injury. This is true for patients with isolated TBI and those with multisystem injury, indicating its utility in predicting outcomes for TBI patients with elevated SIPA regardless of presence of concomitant injuries. Incorporation of this as a triage tool should be considered to better predict resources in this population.
Level Of Evidence:
Prognostic, level III.
