Related Experiment Video
Updated: Jun 21, 2025
Description of a Swine Infant Model of Volume-Controlled Hemorrhagic Shock
Published on: November 3, 2023
Predicting severe outcomes in pediatric trauma patients: Shock index pediatric age-adjusted vs. age-adjusted
Zachary T Sheff1, Meesam M Zaheer2, Melanie C Sinclair3
1Eli Lilly and Company, 893 Delaware St., Indianapolis, IN 46225, USA.
Insights
Age-adjusted tachycardia (AT) shows higher sensitivity than Shock Index Pediatric Age-Adjusted (SIPA) in identifying pediatric trauma patients needing urgent care. However, SIPA offers higher specificity for critical outcomes like mortality and severe injury.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care
- Clinical Assessment Tools
Background:
- Timely intervention is critical for injured pediatric patients in the Emergency Department (ED).
- Shock Index Pediatric Age-Adjusted (SIPA) is recognized for identifying pediatric patients requiring emergency interventions.
- The comparative effectiveness of SIPA against age-adjusted tachycardia (AT) in pediatric trauma remains unevaluated.
Purpose of the Study:
- To compare the predictive performance of SIPA versus AT in pediatric trauma patients.
- To assess the ability of SIPA and AT to predict mortality, severe injury, and the need for emergent interventions.
Main Methods:
- Retrospective analysis of 36,517 pediatric trauma patients (ages 4-16, ISS > 15) from 2013-2020 TQIP PUFs.
- Inclusion criteria: blunt mechanism of injury, age 4-16, Injury Severity Score (ISS) > 15.
- Comparison of sensitivity, specificity, overtriage, and undertriage rates for AT and elevated SIPA in predicting severe outcomes and emergent interventions.
Main Results:
- Elevated SIPA identified 26% of patients as high-risk, compared to 59% by AT.
- Patients with elevated SIPA had higher rates of blood transfusion (22% vs. 12%), in-hospital mortality (10% vs. 5%), and emergent operative interventions (43% vs. 32%) than those identified by AT.
- AT demonstrated higher sensitivity but lower specificity than SIPA for predicting mortality, injury severity, and emergent interventions.
Conclusions:
- Age-adjusted tachycardia (AT) shows superior sensitivity in identifying pediatric trauma patients requiring critical interventions compared to SIPA.
- Shock Index Pediatric Age-Adjusted (SIPA) offers high specificity for predicting mortality, injury severity, and the need for emergent interventions.
- AT's broader classification of 'high risk' influences its overtriage and undertriage rates compared to SIPA.
Introduction:
When an injured patient arrives in the Emergency Department (ED), timely and appropriate care is crucial. Shock Index Pediatric Age-Adjusted (SIPA) has been shown to accurately identify pediatric patients in need of emergency interventions. However, no study has evaluated SIPA against age-adjusted tachycardia (AT). This study aims to compare SIPA with AT in predicting outcomes such as mortality, severe injury, and the need for emergent intervention in pediatric trauma patients.
Material And Methods:
This is a retrospective cross-sectional analysis of patient data abstracted from the Trauma Quality Improvement Program Participant Use Files (TQIP PUFs) for years 2013-2020. Patients aged 4-16 with blunt mechanism of injury and injury severity score (ISS) > 15 were included. 36,517 children met this criteria. Sensitivity, specificity, overtriage, and undertriage rates were calculated to compare the effectiveness of AT and elevated SIPA as predictors of severe injuries and need for emergent intervention. Emergent interventions included craniotomy, endotracheal intubation, thoracotomy, laparotomy, or chest tube placement within 24 h of arrival.
Results:
AT classified 59% of patients as "high risk," while elevated SIPA identified 26%. Compared to AT patients, a greater proportion of patients with elevated SIPA required a blood transfusion within 24 h (22% vs. 12%, respectively; p < 0.001). In-hospital mortality was higher for the elevated SIPA group than AT (10% vs. 5%, respectively; p < 0.001) as well as the need for emergent operative interventions (43% vs. 32% respectively; p < 0.001). Grade 3 or higher liver/spleen lacerations requiring blood transfusion were also more common among elevated SIPA patients than AT patients (8% vs. 4%, respectively; p < 0.001). AT demonstrated greater sensitivity but lower specificity compared to SIPA across all outcomes. AT showed improved overtriage and undertriage rates compared to SIPA, but this is attributed to identifying a large proportion of the sample as "high risk."
Conclusions:
AT outperforms SIPA in sensitivity for mortality, injury severity and emergent interventions in pediatric trauma patients while the specificity of SIPA is high across these outcomes.
