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The Shock Index among Children Presenting to the Emergency Department: Analysis of Nationally Representative Sample
1Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Insights
The Shock Index (SI) in children indicates increased hospitalization and medical interventions. This study evaluated SI variations and their link to emergency department outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Triage
- Biostatistics
Background:
- The Shock Index (SI) is an emerging clinical tool for assessing pediatric patients with injury or suspected sepsis.
- Understanding SI distribution and its association with outcomes in diverse pediatric populations is crucial for emergency care.
Purpose of the Study:
- To evaluate the distribution of the Shock Index (SI) in children presenting to the emergency department (ED).
- To assess the association between various SI calculations and clinical outcomes in pediatric ED patients.
Main Methods:
- Analysis of a complex survey of nonfederal U.S. ED encounters (2016-2021).
- Evaluation of Pediatric Age-Adjusted Shock Index (SIPA), Pediatric Shock Index (PSI), and Temperature- and Age-Adjusted Shock Index (TAMSI) in children.
- Association analysis of SI criteria with disposition, triage acuity, medication administration, diagnoses, and procedures.
Main Results:
- Over 81 million ED visits for children aged 4-16 and 117 million for children aged 1-12 were analyzed.
- Abnormal SI prevalence varied: 15.9% (SIPA), 11.1% (PSI), and 31.7% (TAMSI).
- Elevated SI correlated with increased hospitalization, triage acuity, and medical interventions (IV fluids, blood cultures).
Conclusions:
- An elevated SI in children signifies heightened resource utilization and is linked to clinically significant outcomes in the ED.
- The study highlights the association of SI with critical outcomes, supporting its potential role in pediatric triage.
- Further research is needed to refine SI distribution data and integrate it into pediatric emergency triage algorithms.
Background:
The Shock Index (SI) is emerging as a potentially useful measure among children with injury or suspected sepsis.
Objective:
The aim of this study was to evaluate the distribution of the SI and evaluate its association with clinical outcomes among all children presenting to the emergency department (ED).
Methods:
A complex survey of nonfederal U.S. ED encounters from 2016 through 2021 was analyzed. Among children, the Pediatric Age-Adjusted Shock Index (SIPA), Pediatric Shock Index (PSI), and the Temperature- and Age-Adjusted Shock Index (TAMSI) were analyzed. The association of these criteria with disposition, acuity, medication administration, diagnoses and procedures was analyzed.
Results:
A survey-weighted 81.5 million ED visits were included for children aged 4-16 years and 117.2 million visits were included for children aged 1-12 years. SI could be calculated for 78.6% of patients aged 4-16 years and 57.9% of patients aged 1-12 years. An abnormal SI was present in 15.9%, 11.1%, and 31.7% when using the SIPA, PSI, and TAMSI, respectively. With all criteria, an elevated SI was associated with greater hospitalization. The SIPA and PSI were associated with triage acuity. All criteria were associated with medical interventions, including provision of IV fluids and acquisition of blood cultures.
Conclusions:
An elevated SI is indicative of greater resource utilization needs among children in the ED. When using any criteria, an elevated SI was associated with clinically important outcomes. Further research is required to evaluate the distribution of the SI in children and to investigate its potential role within existing triage algorithms for children in the ED.
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