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Optimizing Triage: Assessing Shock Index, Pediatric Age-Adjusted as an Adjunct to Improve Emergency Severity Index
Eilan Levkowitz1, Robert Gibson2, Hongyan Xu2
1From the Department of Emergency Medicine, Children's Hospital of Georgia, Augusta University, Medical College of Georgia.
Insights
The pediatric age-adjusted shock index (SIPA) effectively predicts severe outcomes in Emergency Severity Index level 3 pediatric patients, including hospital admission and interventions. SIPA
Area of Science:
- Pediatric Emergency Medicine
- Clinical Diagnostics
- Patient Triage
Background:
- Accurate triage is crucial for pediatric emergency care.
- The shock index, pediatric age-adjusted (SIPA) is a potential tool for assessing pediatric patient acuity.
- Understanding SIPA's predictive value in Emergency Severity Index (ESI) level 3 patients is important.
Purpose of the Study:
- To evaluate the diagnostic utility of SIPA in predicting outcomes for ESI level 3 pediatric patients.
- To explore the influence of fever, race, and sex on SIPA's predictive accuracy.
Main Methods:
- Retrospective chart review of 192 children (1-17 years) triaged as ESI level 3.
- Utilized age-specific SIPA thresholds for analysis.
- Assessed elevated SIPA and SIPA corrected for fever against patient outcomes and interventions.
Main Results:
- Elevated SIPA was associated with significantly higher rates of interventions (P < 0.016), hospital admission (P = 0.004), and longer hospital length of stay (LOS).
- Patients with elevated SIPA required more ventilatory support (16.44% vs 3.36%, P < 0.002) and fluid boluses (28.77% vs 14.29%, P < 0.015).
- SIPA's predictive performance was not significantly affected by fever, race, or sex.
Conclusions:
- SIPA is a valuable predictor of adverse outcomes in ESI level 3 pediatric patients.
- SIPA identifies patients likely to need hospital admission, prolonged LOS, and critical interventions.
- SIPA's robustness across demographics supports its use in preventing mistriage and enhancing pediatric emergency care protocols.
Objective:
We investigated the diagnostic value of shock index, pediatric age-adjusted (SIPA) in predicting Emergency Severity Index level 3 patients' outcomes. Secondary objectives included exploring the impact of fever and participant variables on SIPA's predictive ability.
Methods:
A retrospective chart review identified children aged 1 to 15 years triaged as a level 3 in the emergency department between January 2018 and December 2021. Shock index, pediatric age-adjusted thresholds based on age, 1 to 6 years (>1.2), 7 to 12 years (>1.0), and 13 to 17 years (>0.9), were used. We assessed elevated SIPA and SIPA corrected for fever to evaluate associations with outcomes and interventions.
Results:
Our findings, involving 192 patients, revealed that elevated SIPA demonstrated enhanced discrimination relative to nonelevated SIPA. Patients with elevated SIPA had more average interventions: 1.14 versus 0.74, P < 0.016; average interventions using SIPA corrected for fever: 1.14 versus 0.77, P < 0.006; average interventions controlling for race and sex: 1.15 versus 0.71, P < 0.001; hospital admission: 64.4% versus 42.9%, P = 0.004; hospital length of stay (LOS): 3.06 days (SE, 0.42) versus 1.46 days (SE, 0.23); hospital LOS using SIPA corrected for fever: 2.75 days (SE, 0.44) versus 1.72 days (SE, 0.24); ventilatory support: 16.44% versus 3.36%, P < 0.002; fluid bolus: 28.77% versus 14.29%, P < 0.015; intravenous medications (antibiotics, antiepileptics, immune globulin, albumin): 45.21% versus 30.25%, P < 0.036. There was no difference between other interventions, pediatric intensive care admission, and LOS between the 2 groups. Importantly, SIPA was unaffected by fever, race, or sex.
Conclusions:
Shock index, pediatric age-adjusted identifies level 3 Emergency Severity Index pediatric patients more likely to require hospital admission, longer LOS, and a lifesaving intervention especially ventilatory support, intravenous fluids, or specific intravenous medications. Shock index, pediatric age-adjusted's predictive ability remained unaffected by fever, race, or sex, making it a valuable tool in preventing mistriage and justifying inclusion in the Emergency Severity Index danger zone vitals criteria for up-triage.
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