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Establishing pediatric age-adjusted shock index cut points in trauma patients younger than 1 year
Derek Marlor1, Jennifer Flint, Janelle R Noel-MacDonnell
1From the Department of Trauma and Critical Care, Children's Mercy Hospital, Kansas City, Missouri.
Insights
New cut points for the pediatric age-adjusted shock index (SIPA) in infants under 1 year improve prediction of adverse outcomes in pediatric trauma patients. This study establishes reliable SIPA data for this vulnerable age group.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Clinical Assessment Tools
Background:
- The Shock Index (SI) is a predictor of injury severity and adverse outcomes in trauma patients.
- The pediatric age-adjusted shock index (SIPA) demonstrates superior performance in children over 1 year old.
- Optimal SIPA cut points for infants under 1 year have not been well-established.
Purpose of the Study:
- To establish and evaluate pediatric age-adjusted shock index (SIPA) cut point data for patients younger than 1 year.
- To determine the diagnostic performance of different SIPA cut points in this age group.
- To provide data to aid clinical decision-making in infant trauma care.
Main Methods:
- Development of SIPA cut points using age-based vital signs from institutional trauma data for patients <12 months.
- Inclusion of all trauma patients younger than 12 months with recorded clinical outcomes.
- Comparison of age-specific vital sign limits (SIPA-VS) and receiver operating characteristic analysis (SIPA-ROC) against the standard Nordin cut point (SIPA-Nordin).
Main Results:
- Analysis of 483 pediatric trauma patients younger than 12 months.
- SIPA-Nordin was elevated in 81.6% of patients, compared to 21% for SIPA-VS and 31% for SIPA-ROC.
- SIPA-VS and SIPA-ROC showed superior specificity and negative predictive values compared to SIPA-Nordin.
- Elevated SIPA-ROC scores were significantly associated with ICU admission, mechanical ventilation, severe anemia, transfusion, and in-hospital mortality.
Conclusions:
- Pediatric age-adjusted shock index (SIPA) is valuable for identifying infants at risk of complications from severe traumatic injury.
- Proposed SIPA cut points demonstrate high negative predictive value and specificity for various adverse outcomes.
- This study offers crucial data to enhance clinical decision-making for trauma patients under 1 year of age.
Purpose:
Shock Index is used to predict injury severity and adverse outcomes in trauma patients, but pediatric age-adjusted shock index (SIPA) has superior performance in pediatric patients older than 1 year. Pediatric age-adjusted shock index scores younger than 1 year have not been well studied. This project aimed to establish and evaluate SIPA cut point data points for patients younger than 1 year.
Methods:
Using age-based vital signs, we developed cut point values for patients younger than 1 year using our institutional trauma data. All trauma patients younger than 12 months were included, and clinical outcomes were recorded. Pediatric age-adjusted shock index cut points were defined using age-specific vital sign limits (SIPA-VS) and tested against optimal cut points defined by receiver operating characteristic analysis (SIPA-ROC) and a cut point of 1.2 (SIPA-Nordin), which is used for patients aged 1 to 4 years. Student's t test, χ 2 tests, analysis of variance, and test characteristics were used to analyze groups.
Results:
A total of 609 pediatric trauma patients younger than 12 months were identified from 2018 to 2022. Pediatric age-adjusted shock index scores were calculated for 483 patients. There were 406 patients with blunt trauma and 17 with penetrating. SIPA-Nordin was elevated in 81.6% (n = 397) of patients, compared with SIPA-VS 21% (n = 101) and SIPA-ROC 31% (n = 150). In comparison with SIPA-Nordin, both SIPA-VS and SIPA-ROC score exhibited superior specificity and negative predictive values for multiple outcomes. Elevated SIPA-ROC scores had statistically significant associations with intensive care unit admission, mechanical ventilation, severe anemia, transfusion during hospital admission, and in-hospital mortality.
Conclusion:
Pediatric age-adjusted shock index is a useful tool in identifying patients at risk for several complications of severe traumatic injury. Pediatric age-adjusted shock index cut points had high negative predictive value and specificity for many outcomes. This study proposes cut point values that may aid in clinical decision making for trauma patients younger than 1 year.
Level Of Evidence:
Diagnostic Test/Criteria; Level IV.
