Shock index, pediatric age adjusted: A scoping review of applications in pediatric trauma triage and beyond

The objective of this scoping review is to evaluate the utility and limitations of elevated shock index, pediatric age adjusted (SIPA), and provide guidance regarding how and when to use SIPA and highlight gaps in current research. Since its inception, SIPA has become a standard metric used in pediatric trauma triage. We included 38 studies that evaluated SIPA as an outcome in various pediatric trauma populations. Prior research demonstrated that elevated SIPA identifies severely injured children and normal SIPA predicts low risk of intra-abdominal injury necessitating intervention or intensive care unit admission. This suggests that SIPA may be useful in mitigating the overuse of CT in children and reducing misallocation of hospital resources. Elevated SIPA has also been demonstrated to play a role in trauma activation criteria - alone it leads to overtriage; however, it is more useful as part of a scoring system that includes additional factors such as mental status assessment. Similarly, tools that combine SIPA with values that consider coagulopathy and acidosis may improve pediatric massive transfusion protocol activation criteria, which currently lacks consensus-based criterion. Additional research provided evidence for the use of SIPA as a discreet variable, with the degree of elevation above normal indicating increased risk of adverse outcomes. Furthermore, while many new scores have emerged that offer marginal improvement compared with SIPA in the ability to identify injured children, consensus on a single score is lacking, highlighting the need for further research to optimize these tools.