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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.
Insights
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.
Background:
Previous studies have identified the reverse shock index x Glasgow Coma Scale (rSIG) as a tool for predicting the need for trauma intervention in pediatric patients. This study sought to investigate the utility of prehospital rSIG as a triage tool to predict the need for trauma-center level of care in a large pediatric cohort.
Methods:
Data from the American College of Surgeons National Trauma Data Bank (NTDB) (2018-2020) were used. Patients aged 1-18 with valid values for prehospital systolic blood pressure (EMS SBP), prehospital heart rate (EMS HR), and EMS total GCS, were included. Prehospital rSIG was calculated as (EMS SBP/EMS HR) x EMS total GCS. Abnormal values for rSIG were defined as: ≤13.1, ≤16.5, and ≤20.1 for patients aged 1-6, 7-12, and 13-18, respectively. Injury severity was determined by Injury Severity Score (ISS). ISS 1-8 represented minor injury, 9-15 moderate injury, and 16 severe injury. Rates of hemorrhage control surgery, embolization, transfusion at 4 hours, mechanical ventilation, ICU stay 3 days, and mortality was compared between patients with abnormal vs. normal prehospital rSIG.
Results:
120,941 patients were included in the analysis; 60269 (49.8 %) had an abnormal prehospital rSIG. Patients with abnormal prehospital rSIG had significantly higher rates of 1 trauma intervention (23.3 % vs 8.3 %, p < 0.0001) and mortality (2.7 % vs 0.1 %, p < 0.0001). When stratified by injury severity, rates of 1 trauma intervention were significantly higher for patients with abnormal prehospital rSIG in minor (2.8 % vs. 1.5 %, p < 0.0001), moderate (18.9 % vs 10.5 %, p < 0.0001), and severe injury (69.8 % vs 43.1 %).
Conclusion:
Prehospital rSIG appears to be an independent predictor of both trauma intervention and mortality, regardless of injury severity, in the pediatric trauma population. Use of prehospital rSIG may prove useful in triage situations, particularly mass casualty incidents, to determine need for trauma-center care.
