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Prehospital Shock Index as a Predictive Metric for In-Hospital Outcomes in Children
Rohan Bhargava1, Remle Crowe2, Christian Martin-Gill3
1Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Insights
The shock index (SI) in injured children is linked to mortality and hospital admission. However, current SI criteria show limited accuracy in predicting these outcomes, indicating a need for improved pediatric assessment tools.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care
- Clinical Assessment Tools
Background:
- The shock index (SI) is a vital sign ratio that may enhance the assessment of injured children.
- Evaluating prehospital SI is crucial for understanding its association with in-hospital outcomes in pediatric trauma.
Purpose of the Study:
- To assess the association between prehospital shock index (SI) and in-hospital outcomes in injured children.
- To compare the diagnostic accuracy of three different SI criteria (SIPA, PSI, SIZ) for predicting pediatric trauma outcomes.
Main Methods:
- Retrospective cross-sectional analysis of 49,079 injured children (<18 years) from a multiagency prehospital electronic record system (2018-2022).
- Evaluation of SI pediatric age-adjusted (SIPA), pediatric SI (PSI), and age-based Z-score derived (SIZ) cut points.
- Analysis of associations with in-hospital mortality, admission, and elevated Injury Severity Score (ISS > 15).
Main Results:
- Abnormal SI values were observed in 14.4% to 24.1% of patients across different criteria.
- Elevated SI (SIPA, PSI, SIZ) and depressed SI (SIZ) were associated with increased mortality.
- All SI criteria demonstrated poor diagnostic accuracy (sensitivity 14.5-54.3%) for predicting in-hospital outcomes.
Conclusions:
- The shock index (SI) shows an association with in-hospital mortality and admission in injured children.
- Current SI criteria exhibit limited diagnostic accuracy, suggesting restricted predictive value for pediatric trauma outcomes.
Introduction:
The shock index (SI) may improve the pediatric assessment of injured children. We evaluated the association between prehospital SI and in-hospital outcomes among injured children.
Methods:
We conducted a retrospective cross-sectional analysis of injured children (<18 y) from a multiagency prehospital electronic record system (2018-2022). We evaluated the following three SI criteria: SI pediatric age-adjusted (SIPA), pediatric SI (PSI), and age-based Z-score derived (SIZ) cut points. We evaluated the association of each with in-hospital mortality, admission, and elevated injury severity score (ISS > 15).
Results:
Among 49,079 injured children, 116 had mortality, 4773 were hospitalized, and 497 had an elevated ISS. Abnormal SI were observed in 24.1%, 14.4%, and 20.2% of SIPA, PSI, and SIZ, respectively. Elevated SI per SIPA (odds ratio [OR]: 2.50, 95% confidence interval [CI] 1.65-3.75) and PSI (OR 3.88, 95% CI 2.63-5.69) were associated with mortality. SIZ was associated with mortality for both elevated (OR 4.57, 95% CI 3.02-6.86) and depressed (OR: 5.03, 95% CI 2.66-8.16) SI. Admission was associated with elevated SI per SIPA (OR: 1.38), PSI (OR: 1.75), and SIZ (OR: 1.76, 95% CI 1.63-1.90) and with depressed SI per SIZ (OR: 1.41, 95% CI 1.26-1.57). Only a depressed SI under SIZ was associated with elevated ISS (OR: 1.40, 95% CI 1.26-1.57). All criteria demonstrated limited sensitivity (39.4-54.3% for mortality, 21.6-29.6% for admission, and 14.5-24.4% for elevated ISS).
Conclusions:
The SI is associated with the in-hospital outcomes of mortality and admission. However, all criteria demonstrated poor diagnostic accuracy for in-hospital outcomes, suggesting limited predictive value.
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