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Published on: November 9, 2018
Reverse shock index multiplied by the motor component of the Glasgow Coma Scale predicts mortality and need for
Tanner Smida1, Patrick Bonasso, James Bardes
1From the MD/PhD Program (T.S.), West Virginia University; Department of Pediatric Surgery (P.B., F.S.), WVU Medicine Children's; Department of Surgery (J.B.), West Virginia University; John Chambers College of Business and Economics (B.S.P.), Morgantown, West Virginia; Nemours Children's Healthcare (L.G., R.L.); Wolfson Children's Hospital (L.G., R.L.), Jacksonville, Florida; and Department of Pediatric Surgery (R.M.), Arkansas Children's Hospital, Little Rock, Arkansas.
Insights
Reverse shock index times the motor component of the Glasgow Coma Scale (GCS) (rSIM) and reverse shock index times the total GCS (rSIG) are both effective in predicting pediatric trauma mortality. rSIG showed slight superiority in older children, but rSIM offers a simpler calculation for triage.
Area of Science:
- Pediatric trauma care
- Emergency medicine
- Critical care
Background:
- Early identification of high-risk pediatric trauma patients is crucial for improving outcomes.
- The study evaluates novel predictive metrics for pediatric trauma mortality and intervention needs.
Purpose of the Study:
- To compare the performance of reverse shock index times the motor component of the Glasgow Coma Scale (rSIM) against reverse shock index times the total Glasgow Coma Scale (rSIG) in predicting mortality and need for intervention in pediatric trauma.
- To determine if rSIM is a suitable alternative to rSIG for pediatric trauma triage.
Main Methods:
- Analysis of the 2017-2020 National Trauma Data Bank including 77,996 pediatric trauma patients (16 years or younger).
- Exclusion of patients without vital signs on arrival and those undergoing interfacility transport.
- Use of receiver operating characteristic curves and area under the curve (AUROC) to compare the predictive performance of rSIM and rSIG for mortality and secondary outcomes.
Main Results:
- Both rSIM and rSIG demonstrated equivalent performance in predicting mortality for younger children (1-5 years).
- rSIG showed statistically significant superiority over rSIM in predicting mortality for older children (6-16 years), with higher AUROCs.
- Both metrics performed similarly in predicting secondary outcomes such as blood product administration or hemorrhage control interventions.
Conclusions:
- Reverse shock index multiplied by GCS-total (rSIG) and GCS-motor (rSIM) are both highly effective in predicting mortality in pediatric trauma patients.
- While rSIG showed a slight advantage in older pediatric age groups, the simplicity of rSIM calculation makes it a potentially valuable tool for rapid pediatric trauma triage.
Background:
Timely identification of high-risk pediatric trauma patients and appropriate resource mobilization may lead to improved outcomes. We hypothesized that reverse shock index times the motor component of the Glasgow Coma Scale (GCS) (rSIM) would perform equivalently to reverse shock index times the total GCS (rSIG) in the prediction of mortality and the need for intervention following pediatric trauma.
Methods:
The 2017-2020 National Trauma Data Bank data sets were used. We included all patients 16 years or younger who had a documented prehospital and trauma bay systolic blood pressure, heart rate, and total GCS. We excluded all patients who arrived at the trauma center without vital signs and interfacility transport patients. Receiver operating characteristic curves were used to model the performance of each metric as a classifier with respect to our primary and secondary outcomes, and the area under the receiver operating characteristic curve (AUROC) was used for comparison. Our primary outcome was mortality before hospital discharge. Secondary outcomes included blood product administration or hemorrhage control intervention (surgery or angiography) <4 hours following hospital arrival and intensive care unit admission.
Results:
After application of exclusion criteria, 77,996 patients were included in our analysis. Reverse shock index times GCS-motor and rSIG performed equivalently as predictors of mortality in the 1- to 2- ( p = 0.05) and 3- to 5-year-old categories ( p = 0.28), but rSIM was statistically outperformed by rSIG in the 6- to 12- (AUROC, 0.96 vs. 0.95; p = 0.04) and 13- to 16-year-old age categories (AUROC, 0.96 vs. 0.95; p < 0.01). Reverse shock index times GCS-motor and rSIG also performed similarly with respect to prediction of secondary outcomes.
Conclusion:
Reverse shock index times GCS-total and rSIM are both outstanding predictors of mortality following pediatric trauma. Statistically significant differences in favor of rSIG were noted in some age groups. Because of the simplicity of calculation, rSIM may be a useful tool for pediatric trauma triage.
Level Of Evidence:
Diagnostic Tests or Criteria; Level III.
