Deriving shock index pediatric age-adjusted thresholds to predict need for emergent intervention

Area of Science:

• Pediatric Emergency Medicine
• Trauma Care
• Clinical Prediction Models

Background:

• The Shock Index (SI) is used to identify patients at risk for severe injury.
• Shock Index Pediatric Age-Adjusted (SIPA) modifies SI thresholds based on age.
• Established SIPA thresholds exist, but empirical validation is needed.

Purpose of the Study:

• To empirically derive optimal age-adjusted shock index (SIPA) cutoffs for pediatric patients.
• To compare the accuracy of empirically derived SIPA cutoffs with established SIPA thresholds.
• To evaluate the utility of SIPA in predicting the need for emergent intervention in pediatric trauma.

Main Methods:

• Analysis of a large pediatric patient dataset (n=484,586) from 2013-2020.
• Utilized the Area Under the Receiver-Operator Characteristic Curve (AUROC) to determine optimal age-specific cutoffs.
• Defined emergent intervention as specific procedures or ICU admission within 24 hours.

Main Results:

• Empirically derived SIPA cutoffs were similar to established thresholds across pediatric age groups.
• Both empirical and established cutoffs demonstrated low overall accuracy in predicting emergent intervention.
• Sensitivity and specificity showed trade-offs, with established cutoffs having higher specificity but lower sensitivity.

Conclusions:

• Empirically derived SIPA cutoffs align with established values but have limited overall accuracy for broad predictions.
• SIPA may be more effective in predicting specific outcomes, such as the need for urgent blood transfusion.
• Further research is needed to refine SIPA's utility in pediatric trauma assessment.