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Updated: Aug 7, 2026
Description of a Swine Infant Model of Volume-Controlled Hemorrhagic Shock
Published on: November 3, 2023
Comparative predictive value of the transfusion-adjusted shock score to shock index-pediatric adjusted in determining
Rebecca Ng1, Sean Hurley1, Sathyaprasad Burjonrappa1
1Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Division of Pediatric Surgery, Rutgers RWJMS, Medical Education Building, Rm 500, New Brunswick, NJ, 08901, USA.
Introduction:
Shock Index-Pediatric Adjusted (SIPA) is used to predict surgical intervention using heart rate and systolic blood pressure. This study compared SIPA with the Transfusion-Adjusted Shock Score (TASS), which incorporates early blood transfusion into SIPA, for predicting surgical intervention.
Methods:
The 2017-2019 National Trauma Data Bank was analyzed for patients aged 1-15 years with blunt liver or spleen injuries. Severity of transfusions within 4 h of Emergency Department arrival was scored by the number of transfused units to determine Blood Score (BS). Predetermined CSI-PA age-specific cutoffs (1-3, 4-6, 7-12, and 13-18) were used to derive binary SIPA values and subsequently added to BS. Receiver Operating Characteristic (ROC) analysis against surgical intervention was then performed for each age group to build the Surgical Shock Index (SSI), using the maximum Youden Index for cutoff levels. TASS was calculated by adding BS to the SSI. ROC analyses compared TASS and SIPA overall and by age group.
Results:
Among 6477 patients, abnormal TASS and SIPA were present in 38.49% and 45.98%, respectively. Statistically significant differences were determined using chi-squared analysis for total and age groups for both TASS and SIPA (p < 0.001). Overall, TASS demonstrated a moderately higher sensitivity than SIPA, while SIPA demonstrated a moderately higher specificity than TASS. Discrimination was moderately higher for TASS (AUC = 0.678) than SIPA (AUC = 0.579). When segmented by age, TASS demonstrated higher sensitivity while SIPA demonstrated higher specificity except in ages 4-6. Discrimination for ages 4-6 and 7-12 outperformed other ages in both TASS and SIPA.
Conclusion:
Incorporating early transfusion into SIPA improved sensitivity and discrimination for predicting need for surgical intervention. Performance varied by age, supporting age-dependent application of pediatric trauma indices.
