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Predicting morbidity and mortality in Australian paediatric trauma with the Paediatric Age-Adjusted Shock Index and
Jineel H Raythatha1, Harleen Aulakh2, Stephen Yang2
1Trauma unit, Department of Surgery, Children's Hospital at Westmead, Australia; Department of Surgery, School of Medicine, Faculty of Medicine and Health, University of Sydney, Australia.
Insights
The paediatric age-adjusted shock index (SIPA) combined with Glasgow Coma Scale (SIPAms) effectively predicts major paediatric trauma outcomes, including mortality and ICU admission. This combined score shows improved reliability, especially upon patient arrival.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Paediatric Critical Care
Background:
- The paediatric age-adjusted shock index (SIPA) is a potential predictor of morbidity and mortality in paediatric trauma.
- Previous studies indicated poor sensitivity and generalizability of SIPA, limiting its clinical application.
- This study aimed to evaluate SIPA's utility in Australian paediatric trauma patients and its combination with the Glasgow Coma Scale (GCS).
Purpose of the Study:
- To assess the predictive value of SIPA and SIPA combined with GCS (SIPAms) in a general paediatric trauma population.
- To determine the reliability of SIPA and SIPAms in predicting various trauma outcomes, including morbidity, mortality, and resource utilization.
- To compare the performance of pre-arrival (pSIPA, pSIPAms) and arrival (aSIPA, aSIPAms) calculations.
Main Methods:
- Retrospective review of 480 paediatric trauma patients from January 2015 to August 2020 at a major Australian trauma centre.
- Calculation of pre-arrival (pSIPA) and arrival (aSIPA) shock index values.
- Definition of SIPA with mental state (SIPAms) as positive if SIPA was elevated or GCS ≤ 13, for both pre-arrival (pSIPAms) and arrival (aSIPAms).
Main Results:
- SIPA alone (pSIPA, aSIPA) showed poor prediction of morbidity, with only aSIPA predicting mortality.
- Both pSIPAms and aSIPAms significantly predicted mortality, major trauma (ISS≥12), hospital length of stay (LOS), ICU admission, and major surgery.
- aSIPAms demonstrated a sensitivity of 76% and specificity of 70% for identifying major trauma.
- Higher Injury Severity Scores (ISS) and lactate levels were observed in patients with positive SIPA and SIPAms scores.
Conclusions:
- Broad inclusion criteria limit SIPA's predictive ability for morbidity.
- Combining SIPA with GCS (SIPAms) enhances its predictive value, particularly when calculated upon arrival.
- The SIPAms score is more reliable for identifying major trauma (ISS≥12).
- Future research should explore the integration of SIPAms into trauma activation criteria.
Background:
Paediatric age-adjusted shock index (SIPA) has emerged as a predictor of morbidity and mortality in trauma. Poor sensitivity and low generalisability demonstrated in previous studies have limited its use. We evaluate the use of SIPA in the general Australian paediatric trauma population and the combination of SIPA with GCS.
Methods:
All patients from January 2015 to August 2020 at a major Australian paediatric trauma centre were reviewed. Pre-arrival SIPA (pSIPA) and arrival SIPA (aSIPA) were calculated. If SIPA was elevated or the Glasgow Coma Scale ≤ 13, SIPA with mental state (SIPAms) was marked positive for pre-arrival (pSIPAms) and arrival (aSIPAms) respectively.
Results/Discussion:
Data from 480 patients were analysed. pSIPA and aSIPA poorly predicted outcomes of morbidity. Only aSIPA predicted mortality. However, both pre-arrival and arrival SIPAms variables predict mortality, major trauma (ISS≥12), hospital LOS, need for ICU admission, and major surgery. Furthermore, median ISS and lactate were significantly higher in positive pSIPA, aSIPA, pSIPAms, and aSIPAms groups than negative. aSIPAms has a sensitivity of 76% and specificity of 70% for major trauma.
Conclusion:
Broad inclusion criteria reduce SIPA's ability to predict morbidity. Combining it with GCS improves this and is most valuable when calculated at arrival. In addition, the score is more reliable for major trauma (ISS≥12). Future studies should evaluate the use of SIPAms in activation criteria.
