Trends in pediatric adjusted shock index predict morbidity and mortality in children with severe blunt injuries

Vandewalle, Robert J.; Peceny, Julia K.; Dolejs, Scott C.; Raymond, Jodi; Rouse, Thomas M.

doi:10.1016/j.jpedsurg.2017.10.045

Cited by 39 publications

(33 citation statements)

References 13 publications

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“…In evaluating this cohort, the inclusion/exclusion criteria created by Acker et al and used in a previous study evaluating trends in SIPA were utilized with the exception that only patients with an ISS 10-14 were included [5,12]. The trauma registry from a single institution (Riley Hospital for Children at IU Health, Indianapolis, Indiana) was queried for all patients sustaining blunt injuries with an ISS of 10-14 from January 1, 2010 to December 31, 2016.…”

Section: Methodsmentioning

confidence: 99%

“…Children were excluded from the study cohort if they were less than 4 years old or greater than 16 years old. While measuring SIPA at arrival in children less than 4 years of age has been shown to be valid, we chose to keep this age restriction to better parallel work previously completed at our institution [11,12]. Additionally, patients were excluded if they presented to our institution more than 12 hours (h) after injury.…”

Section: Methodsmentioning

confidence: 99%

“…Previous research from our institution suggests that following SIPA after admission serves as a prognostic tool for multiple indices of morbidity and mortality in pediatric patients with severe blunt injury [12]. This study utilized a cohort of patients that mirrored those reported by Acker et al [5].…”

Section: Introductionmentioning

confidence: 96%

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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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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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“…The age specific cutoffs for SI in children are 1.22 (age 4–6), >1.0 (age 7–12), and >0.9 (age 13–16). [567]…”

Section: Methodsmentioning

confidence: 99%

“…[6] Effect of SI on clinical outcomes has been previously reported. [567] However, whether prehospital transport factors such as mode of transport and referral from another hospital affect SI and clinical outcomes has not been evaluated in acutely ill children. Our aim was to evaluate the effect of these prehospital transport factors on admission of SI values and mortality.…”

Section: Introductionmentioning

confidence: 99%