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Triage Pediatric Age-Adjusted Shock Index as a Predictor of Hospital Admission
Mishuka Adhikary1, Ellen J Silver2, Daniel M Fein1
1Department of Pediatrics, Children's Hospital at Montefiore Einstein, Bronx, New York; Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.
Insights
Elevated pediatric age-adjusted shock index (SIPA) in the emergency department predicts higher hospital admission rates and intensive care unit stays. This vital sign offers a promising tool for predicting patient disposition and outcomes in pediatric trauma.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Triage
- Prognostic Biomarkers
Background:
- Shock index (SI) is a key prognostic tool for shock severity, morbidity, and mortality in trauma patients.
- Emergency department (ED) triage SI shows potential for predicting hospital admission and mortality in adults.
- Pediatric age-adjusted shock index (SIPA) is validated for identifying mortality in pediatric blunt trauma.
Purpose of the Study:
- To evaluate the predictive value of ED triage SIPA for patient disposition in pediatric patients.
- To determine if SIPA can forecast hospital admission and critical care needs.
Main Methods:
- Retrospective chart review of pediatric patients (aged 4-20) in a quaternary care pediatric ED.
- Categorization of initial SIPA values as high or low using established age-based cutoffs.
- Analysis of the association between high SIPA and inpatient admission, including ICU admission and rapid response events.
Main Results:
- High triage SIPA was linked to younger age, female sex, lower Emergency Severity Index scores, and conditions like fever, sepsis, dehydration, and respiratory distress.
- Patients with high triage SIPA were 2.4 times more likely to be admitted.
- High SIPA correlated with increased odds of ICU admission (OR 3.2) and rapid response (OR 3.9) within 24 hours of admission.
Conclusions:
- Elevated triage SIPA in pediatric patients is significantly associated with increased likelihood of hospital admission.
- High SIPA predicts higher odds of intensive care unit admission and need for rapid response within the first 24 hours post-admission.
Background:
Shock index (SI), the ratio of heart rate to systolic blood pressure, is a valuable prognostic tool for assessing shock severity and predicting morbidity and mortality in trauma. Emergency department (ED) triage SI shows promise as an alternative prognostic tool for predicting hospital admission and inpatient mortality in adults. Pediatric age-adjusted shock index (SIPA) has been validated for identification of mortality in children with blunt trauma.
Objective:
To determine whether ED triage SIPA can be used to predict disposition.
Methods:
Retrospective chart review of patients aged 4-20 years who were either admitted or discharged from a quaternary care pediatric ED in 2019. Initial SIPA values were characterized as high or low based on established age-based cutoffs. Association between high SIPA and inpatient admission was evaluated.
Results:
There were 29,064 eligible ED encounters in the study period. High triage SIPA was associated with female sex, age less than 12 years old, emergency severity index 1-2, and clinical conditions involving fever, sepsis, dehydration and respiratory distress. Overall, those with high triage SIPA were 2.4 (95% CI 2.21-2.60) times more likely to be admitted. Among admitted patients, high triage SIPA was associated with higher odds of intensive care unit admission (OR 3.2; 95% CI 2.5-4.2) and higher odds of rapid response (OR 3.9; 95% CI 1.8-8.7) within the first 24 hours on the inpatient unit.
Conclusion:
Elevated triage SIPA is associated with higher odds of admission, intensive care unit admission and rapid response in first 24 hours of admission.
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