This article has been retracted due to the unknown origin of the data, lack of verified IRB approval, and purchased authorships. It was also discovered that the article was not submitted by Sher Wali, but by Rahil Barkat while using the account of Sher Wali. Mr. Barkat was involved in data theft and misuse in two recently published Cureus articles, which have since been retracted.
Background
Maintaining hemodynamic stability requires constant complex interaction between multiple vascular and extravascular factors. There are varieties of parameters that determine the same and few of them are used to predict the hemodynamic instability at earliest. Shock Index (SI), Modified Shock Index (MSI) and Shock Index-Pediatric age-Adjusted (SIPA) have been studied constantly in different clinical settings. They are best non-invasive measures for early prediction in resource poor setting or at community referral centers. We would like to compare the predictive value of each parameter in our tertiary care center.
Methods
It was a retrospective study carried out in PICU of a tertiary care centre and includes data collected from 15 August 2019 to 14 August 2021 over a period of 2 years. We recorded demographic data, age, gender, final diagnosis, outcome, and length of stay in PICU. We compared Outcome (Survived/Expired) and length of stay with SI ≥ 0.7 or < 0.7, MSI ≥ 1.3 or < 1.3 and SIPA > 1.22 or < 1.22 (age 4–6 years) > 1 or < 1 (7–12 years) and > 0.9 or < 0.9 (13–16 years).
Results
This study includes 235 children who were admitted to PICU during study period. The median age was 8 years the median length of stay was 5 days and mortality rate being 11.48% (27). Median SI, MSI were 0.78, 1.6 respectively. 61.70% (145) of patients had SI > 0.7. Median value of SI for septic shock patients was 0.92 on admission. The mortality of the patients with SI > 0.7 was 13.10% (19) and those with MSI > 1.3 was 14.89% (21). Mortality in accordance with SIPA for ages 4–6 years, 7–12 years, and 13–16 years were 15.25% (9), 23% (9) and 19.23% (5) respectively. Basically, SIPA was designed to monitor post trauma cases but in our study we got significant correlation with outcome and length of stay in conditions other than trauma.
Conclusions
The SI, MSI, and SIPA are simple bedside parameters may be used for prioritizing the patients who require strict monitoring on admission to PICU and intervention whenever required. These parameters were best in predicting the severity of sepsis and septic shock in comparison to other diagnosis. SIPA can be generalised for monitoring any high-risk case.
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