SIPA Poorly Predicts Outcomes in Young Pediatric Trauma Patients

Area of Science:

• Pediatric Trauma Care
• Emergency Medicine
• Clinical Triage

Background:

• The Shock Index Pediatric Adjusted (SIPA) score is used to predict outcomes in pediatric trauma.
• SIPA's predictive accuracy is lower in younger children compared to older pediatric patients.
• Existing research highlights a gap in the reliable application of SIPA for very young patients.

Purpose of the Study:

• To evaluate the predictive capability of SIPA for blood transfusion (BT), hemorrhage control interventions (HCI), need for trauma intervention (NFTI), and mortality across different pediatric age groups (1-14 years).
• To identify age-specific SIPA cut-points for improved prediction of critical outcomes.
• To delineate the challenges in using SIPA for triage in younger pediatric populations.

Main Methods:

• Analysis of the American College of Surgeons National Trauma Data Store (ACS NTDB) from 2017-2021.
• Inclusion of pediatric patients aged 1-14 years transported by EMS.
• Stratification into three age groups: 1-4, 5-9, and 10-14 years.
• Application of recursive partitioning to determine SIPA cut-points and Area Under the Curve (AUC) for outcome prediction.

Main Results:

• Four SIPA cut-points were identified for each age group.
• SIPA demonstrated higher predictive value for HCI compared to other outcomes.
• Blood transfusion (BT) prediction aligned with previous studies.
• SIPA showed limited discrimination for NFTI and mortality, with slightly better performance in older children.

Conclusions:

• SIPA effectively predicts BT and HCI but has poor predictive value for NFTI and mortality in pediatric trauma patients.
• Younger pediatric patients remain challenging to triage accurately using SIPA alone.
• Combined use of SIPA with other scores and development of pediatric-specific NFTI criteria are recommended for improved triage.