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Prehospital Reverse Shock Index Times Glasgow Coma Scale as a Predictor for Trauma Intervention in Paediatric Trauma
Nicholas J Dante1, Ryan J Salvatore1, Nicolas L Carayannopoulos1
1Department of Paediatric Surgery, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, Suite 3300, New Brunswick, NJ, 08901, USA.
Journal of Pediatric Surgery
|November 3, 2024
Summary
The reverse shock index x Glasgow Coma Scale (rSIG) effectively predicts trauma intervention and mortality in pediatric patients. This tool aids in prehospital triage, especially in mass casualty incidents, to identify patients needing trauma center care.
Area of Science:
- Trauma care and emergency medicine
- Pediatric critical care
- Clinical decision support tools
Background:
- The reverse shock index x Glasgow Coma Scale (rSIG) has shown promise in identifying pediatric trauma intervention needs.
- The utility of prehospital rSIG as a triage tool for determining the necessity of trauma-center care in pediatric patients requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness of prehospital rSIG in predicting the need for trauma-center level care in a large pediatric cohort.
- To assess the association between prehospital rSIG and trauma interventions, including surgery, transfusion, ventilation, ICU admission, and mortality.
Main Methods:
- Utilized data from the American College of Surgeons National Trauma Data Bank (2018-2020) for patients aged 1-18.
- Calculated prehospital rSIG using prehospital systolic blood pressure, heart rate, and total GCS; defined abnormal values based on age-specific thresholds.
- Compared rates of trauma interventions and mortality between patients with abnormal and normal prehospital rSIG, stratified by injury severity (ISS).
Main Results:
- Over 120,000 pediatric patients were analyzed, with 49.8% exhibiting abnormal prehospital rSIG.
- Patients with abnormal prehospital rSIG demonstrated significantly higher rates of trauma intervention (23.3% vs. 8.3%) and mortality (2.7% vs. 0.1%).
- Abnormal prehospital rSIG was associated with increased trauma intervention rates across all injury severities: minor (2.8% vs. 1.5%), moderate (18.9% vs. 10.5%), and severe (69.8% vs. 43.1%).
Conclusions:
- Prehospital rSIG is an independent predictor of trauma intervention and mortality in pediatric trauma patients, irrespective of injury severity.
- The prehospital rSIG can serve as a valuable triage tool, particularly in mass casualty incidents, to guide decisions regarding trauma center care.
