Prospective validation of the shock index pediatric-adjusted (SIPA) in blunt liver and spleen trauma: An ATOMAC+ study

Linnaus, Maria E.; Notrica, David M.; Langlais, Crystal S.; Peter, Shawn D. St.; Leys, Charles M.; Ostlie, Daniel J.; Maxson, R. Todd; Ponsky, Todd A.; Tuggle, David W.; Eubanks, James W.; Bhatia, Amina; Alder, Adam C.; Greenwell, Cynthia; Garcia, Nilda M.; Lawson, Karla A.; Motghare, Prasenjeet; Letton, Robert W.

doi:10.1016/j.jpedsurg.2016.09.060

Cited by 56 publications

(37 citation statements)

References 9 publications

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“…Shock Index is associated with mortality in children with septic shock 12 13. Research on Shock Index in EDs has mainly focused on injured patients 14 15. No reference values exist for the whole age range in children.…”

Section: Discussionmentioning

confidence: 99%

“…Another measure of haemodynamic status is Shock Index, the ratio of heart rate to systolic BP, which is associated with mortality and disease severity in adults 9–11. In small cohorts of children, elevated Shock Index has been associated with injury severity in trauma and mortality in septic shock 12–15. However, the Shock Index in all paediatric ED patients has not yet been evaluated and could be an important predictor in children.…”

Section: Introductionmentioning

confidence: 99%

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Association between hypotension and serious illness in the emergency department: an observational study

2019

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BackgroundThe value of routine blood pressure measurement in the emergency department (ED) is unclear.ObjectiveTo determine the association between hypotension in addition to tachycardia and the Shock Index for serious illness.DesignObservational study.SettingUniversity ED (2009–2016).Participants, methods and main outcomesRoutine data collected from consecutive children <16 years. Using logistic regression, we assessed the association between hypotension (adjusted for tachycardia) and Shock Index (ratio heart rate/blood pressure [BP]) for serious illness. The predictive accuracy (sensitivity, specificity) for hypotension and Shock Index was determined for serious illness, defined as intensive care unit (ICU) and hospital admissions.ResultsWe included 10 698 children with measured BP. According to three age-adjusted clinical cut-offs (Advanced Paediatric Life Support, Paediatric Advanced Life Support and Paediatric Early Warning Score), hypotension was significantly associated with ICU admission when adjusted for tachycardia (range OR 2.6–5.3). Hypotension showed low sensitivity (range 0.05–0.12) and high specificity (range 0.95–0.99) for ICU admission. Combining hypotension and tachycardia did not change the predictive value for ICU admission. Similar results were found for hospitalisation. Shock index was associated with serious illness. However, no specific cut-off value was identified in different age groups.ConclusionsHypotension, adjusted for tachycardia, is associated with serious illness, although its sensitivity is limited. Shock index showed an association with serious illness, but no acceptable cut-off value could be identified. Routine BP measurement in all children to detect hypotension has limited value in the ED. Future studies need to confirm which patients could benefit from BP measurement.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between hypotension and serious illness in the emergency department: an observational study

2019

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“…SIPA has since been validated in a prospective pediatric study of 386 patients in blunt liver and spleen injury (BLSI) 3. Outcomes were blood transfusion in first 24 hrs, ISS >24, grade ≥3 BLSI requiring transfusion, need for operation, ICU admission, and in-hospital mortality.…”

Section: Pediatricsmentioning

confidence: 99%

“…Age × SI has been shown to be more indicative of mortality in geriatric patients 6. The pediatric adjusted shock index (SIPA) was developed for pediatric populations and has proven to be more reliable than the standard adult cutoffs 2,3,8. Despite these advances, there is no consensus on when, where, and if SI has a role in the emergency department (ED).…”

Section: Introductionmentioning

confidence: 99%

<p>Shock index in the emergency department: utility and limitations</p>

Koch¹,

Lovett²,

Nghiem³

et al. 2019

OAEM

125

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Shock index (SI) is defined as the heart rate (HR) divided by systolic blood pressure (SBP). It has been studied in patients either at risk of or experiencing shock from a variety of causes: trauma, hemorrhage, myocardial infarction, pulmonary embolism, sepsis, and ruptured ectopic pregnancy. While HR and SBP have traditionally been used to characterize shock in these patients, they often appear normal in the compensatory phase of shock and can be confounded by factors such as medications (eg, antihypertensives, beta-agonists). SI >1.0 has been widely found to predict increased risk of mortality and other markers of morbidity, such as need for massive transfusion protocol activation and admission to intensive care units. Recent research has aimed to study the use of SI in patients immediately on arrival to the emergency department (ED). In this review, we summarize the literature pertaining to use of SI across a variety of settings in the management of ED patients, in order to provide context for use of this measure in the triage and management of critically ill patients.

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“…Within the last five years, Acker et al have defined pediatric-adjusted SI (SIPA) values for children based upon vital signs across accepted age ranges and validated this model as a predictor for injury severity in blunt trauma [5]. Subsequent research has found SIPA useful in identification of severe head injury, identification of severe isolated blunt liver/spleen injury, need for trauma team activation, and need for abdominal CT after blunt trauma injury [6][7][8][9][10]. The most recent research has validated SIPA utilizing the Pediatric Trauma Quality Improvement Program (TQIP) database across a more diverse pediatric trauma population and as a triage tool for intensive care unit admission after isolated high grade solid organ injury [9,11].…”

Section: Introductionmentioning

confidence: 99%

Trends in pediatric-adjusted shock index predict morbidity in children with moderate blunt injuries

et al. 2019

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PURPOSE: Trending the pediatric-adjusted shock index (SIPA) after admission has been described for children suffering severe blunt injuries (i.e. injury severity score (ISS)>15). We propose that following SIPA in children with moderate blunt injuries, as defined by ISS 10-14, has similar utility. METHODS: The trauma registry at a single institution was queried over a seven year period. Patients were included if they were between 4-16 years old at the time of admission, sustained a blunt injury with an ISS 10-14, and were admitted less than 12 hours after their injury (n=501). Each patient's SIPA was then calculated at 0, 12, 24, 36, and 48 hours (h) after admission and then categorized as elevated or normal at each time frame based upon previously reported values. Trends in outcome variables as a function of time from admission for patients with an abnormal SIPA to normalize as well as patients with a normal admission SIPA to abnormal were analyzed. RESULTS: In patients with a normal SIPA at arrival, elevation within the first 24h of admission correlated with increased length of stay (LOS). Increased transfusion requirement, incidence of infectious complications, and need for in-patient rehabilitation were also seen in analyzed subgroups. An elevated SIPA at arrival with increased length of time to normalize SIPA correlated with increased length of stay LOS in the entire cohort and in those without head injury, but not in patients with a head injury. No deaths occurred within the study cohort. CONCLUSIONS: Patients with an ISS 10-14 and a normal SIPA at time of arrival who then have an elevated SIPA in the first 24h of admission are at increased risk for morbidity including longer LOS and infectious complications. Similarly, time to normalize an elevated admission SIPA appears to directly correlate with LOS in patients without head injuries. No correlations with markers for morbidity could be identified in patients with a head injury and an elevated SIPA at arrival. This may be due to small sample size, as there were no relations to severity of head injury as measured by Head Abbreviated Injury Scale (Head AIS) and the outcome variables reported. This is an area of ongoing analysis. This study extends the previously reported utility of following SIPA after admission into milder blunt injuries

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Prospective validation of the shock index pediatric-adjusted (SIPA) in blunt liver and spleen trauma: An ATOMAC+ study

Cited by 56 publications

References 9 publications

Association between hypotension and serious illness in the emergency department: an observational study

Association between hypotension and serious illness in the emergency department: an observational study

<p>Shock index in the emergency department: utility and limitations</p>

Trends in pediatric-adjusted shock index predict morbidity in children with moderate blunt injuries

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