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Improved identification of severely injured pediatric trauma patients using reverse shock index multiplied by Glasgow
Marina L Reppucci1, Shannon N Acker, Emily Cooper
1From the Pediatric Surgery (M.L.R., S.N.A., J.S., R.P., S.L.M., D.D.B.), Children's Hospital Colorado, Aurora, Colorado; Division of Pediatric Surgery, Department of Surgery (M.L.R., S.N.A., J.S., R.P., S.L.M., D.D.B.), University of Colorado School of Medicine, Aurora, CO; The Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery (E.C., M.M.), University of Colorado School of Medicine, Aurora, CO; and Department of Surgery (D.D.B.), Denver Health Medical Center, Denver, CO.
Insights
The new rSIG score, combining reverse shock index and Glasgow Coma Scale, accurately predicts early interventions in pediatric trauma patients. This tool aids in rapid identification of children needing critical care, outperforming older methods.
Area of Science:
- Pediatric Trauma Care
- Clinical Triage Tools
- Outcome Prediction in Trauma
Background:
- Pediatric age-adjusted shock index (SIPA) predicts resource needs and mortality in pediatric trauma but excludes neurological status.
- Reverse shock index (rSI) multiplied by Glasgow Coma Scale (GCS) (rSIG) shows promise in adult trauma and pediatric mortality prediction.
- Current scoring systems lack comprehensive assessment for early intervention needs in pediatric trauma.
Purpose of the Study:
- To compare the accuracy of rSIG against Shock Index (SI) and SIPA.
- To evaluate the prediction of early interventions in civilian pediatric trauma patients using rSIG.
- To assess the utility of rSIG as a bedside triage tool.
Main Methods:
- Analysis of 604,931 pediatric trauma patients (aged 1-18) from the 2014-2018 Pediatric Trauma Quality Improvement Program database.
- Calculation of optimal cut points for rSIG to predict blood transfusion, intubation, ICP monitoring, and ICU admission.
- Receiver operating characteristic analyses to compare the predictive performance of rSIG, SI, and SIPA.
Main Results:
- rSIG demonstrated superior performance compared to SI and SIPA in predicting early trauma outcomes across the entire pediatric population.
- The study included a large cohort with a mean age of 11.1 years and a mean Injury Severity Score of 7.6.
- rSIG scores averaged 18.6, while SI scores averaged 0.85 in this cohort.
Conclusions:
- rSIG effectively identifies pediatric trauma patients requiring early interventions like transfusion, intubation, or ICU admission.
- Incorporating neurological status via GCS, rSIG offers a more comprehensive initial assessment.
- rSIG serves as a valuable bedside triage tool for rapid identification of pediatric trauma patients needing advanced care.
Background:
The shock index pediatric age-adjusted (SIPA) predicts the need for increased resources and mortality among pediatric trauma patients without incorporating neurological status. A new scoring tool, rSIG, which is the reverse shock index (rSI) multiplied by the Glasgow Coma Scale (GCS), has been proven superior at predicting outcomes in adult trauma patients and mortality in pediatric patients compared with traditional scoring systems. We sought to compare the accuracy of rSIG to Shock Index (SI) and SIPA in predicting the need for early interventions in civilian pediatric trauma patients.
Methods:
Patients (aged 1-18 years) in the 2014 to 2018 Pediatric Trauma Quality Improvement Program database with complete heart rate, systolic blood pressure, and total GCS were included. Optimal cut points of rSIG were calculated for predicting blood transfusion within 4 hours, intubation, intracranial pressure monitoring, and intensive care unit admission. From the optimal thresholds, sensitivity, specificity, and area under the curve were calculated from receiver operating characteristics analyses to predict each outcome and compared with SI and SIPA.
Results:
A total of 604,931 patients with a mean age of 11.1 years old were included. A minority of patients had a penetrating injury mechanism (5.6%) and the mean Injury Severity Score was 7.6. The mean SI and rSIG scores were 0.85 and 18.6, respectively. Reverse shock index multiplied by Glasgow Coma Scale performed better than SI and SIPA at predicting early trauma outcomes for the overall population, regardless of age.
Conclusion:
Reverse shock index multiplied by Glasgow Coma Scale outperformed SI and SIPA in the early identification of traumatically injured children at risk for early interventions, such as blood transfusion within 4 hours, intubation, intracranial pressure monitoring, and intensive care unit admission. Reverse shock index multiplied by Glasgow Coma Scale adds neurological status in initial patient assessment and may be used as a bedside triage tool to rapidly identify pediatric patients who will likely require early intervention and higher levels of care.
Level Of Evidence:
Prognostic, level III.
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