Pediatric Shock Across Acute Emergencies: Age Patterns, Etiologic Subtypes, and Bedside Clinical Indicators in a...

Background/Objectives: Pediatric shock is a final common pathway of cardiovascular failure across diverse emergencies, yet data from mixed emergency cohorts outside intensive care units remain limited. This study aimed to describe the distribution, etiologic subtypes, and clinical correlates of shock in children presenting within a diagnosis-based emergency cohort. Methods: A retrospective single-centre study was conducted in children aged 0-16 years presenting with selected acute pediatric emergencies, among whom cases with and without shock were compared. Shock was defined using documented diagnoses and compatible hemodynamic features, and multiple etiologic types of shock were analyzed, including hypovolemic, septic, cardiogenic, and anaphylactic shock. Demographic and diagnostic variables-age, length of stay, organ support, age strata, and selected comorbidities-and baseline clinical features were compared between children with and without shock using non-parametric and χ²/Fisher's exact tests. Results: Within the prespecified diagnosis-based analytic cohort, 36/128 children (28.1%) met the study criteria for shock and occurred across all prespecified acute pediatric emergency groups, with the highest proportional burden in heart failure and meningitis; this proportion should not be interpreted as an emergency-department prevalence estimate. Children with shock were younger, with clustering in infants < 1 year and those aged 5-9 years, and tended to stay longer in hospital. Pre-existing cardiac disease, severe dehydration, and altered mental status/coma were more frequent among children with shock. Septic and cardiogenic shock required the most intensive organ support. Conclusions: In this pediatric emergency cohort, shock emerged as a clinically relevant and etiologically heterogeneous complication across diverse acute presentations, with a distinct age-related vulnerability pattern and consistent associations with readily identifiable bedside clinical features. Simple bedside information-particularly cardiac comorbidity, dehydration, and altered consciousness-may assist the early recognition of children with evolving circulatory failure and support closer monitoring and timely escalation of care. By focusing on a mixed emergency population outside the intensive care unit, this study provides a real-world clinical perspective that may help refine early bedside assessment and improve vigilance for shock in pediatric emergency departments.