Validation of the age-adjusted shock index using pediatric trauma quality improvement program data

Nordin, Andrew B.; Coleman, Alan; Shi, Junxin; Wheeler, Krista K.; Xiang, Henry; Acker, Shannon N.; Bensard, Denis D.; Kenney, Brian D.

doi:10.1016/j.jpedsurg.2017.10.023

Cited by 68 publications

(82 citation statements)

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“…However, a more recent study has shown that SIPA has utility for patients beyond this study's criteria (i.e. age, injury severity, and injury mechanism) [11]. Because SIPA may have utility in patients beyond those in which it was initially described, we hypothesize that trends in SIPA will have value as a prognostic tool for patients with moderate blunt injury (i.e.…”

Section: Introductionmentioning

confidence: 84%

“…Feasibility of this study was based upon work previous work completed at our institution as well as a recent multi-institutional collaboration that validated the shock index across a broad spectrum of pediatric trauma patients [11,12]. Indeed, when comparing patients within our study cohort with an elevated SIPA at arrival to those who did not, there were multiple markers of increased morbidity.…”

Section: Discussionmentioning

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%

“…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]. Cutoff values for SIPA are as follows: 1.22 (ages 4-6 years), 1.0 (ages 7-12), and 0.9 (ages 13-16) with values above these cutoffs considered abnormal.…”

Section: Introductionmentioning

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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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: Introductionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

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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“…Previous studies have reported that shock index (SI), which is calculated by the normal heart rate divided by the SBP, predicted mortality among pediatric patients with trauma and served as a requirement for transfusion [24,25]. The prediction of blood transfusion by using SI may be used for the necessity of transfusion due to its high negative predictive value.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Assessment of Blood Consumption score for pediatrics (ped-ABC score) predicts transfusion requirements for children with trauma.

Komori

Deshpande

Aoki

et al. 2020

Preprint

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Background Although transfusion is one of primary life-saving elements, the assessment of requirement for transfusion in children with trauma at an early phase has been challenging. We aimed to develop a scoring system for predicting transfusion requirements in children with trauma. Methods This is a retrospective cohort study, which employed a nationwide registry of patients with trauma (Japan Trauma Data Bank) and included the patients aged < 16 years with blunt trauma between 2004 and 2015. An Assessment of Blood Consumption score for pediatrics (ped-ABC score) was developed based on previous literatures and clinical relevance. One point was assigned for each of the following criteria: systolic blood pressure ≤ 90 mmHg; heart rate ≥ 120/min; Glasgow Coma Scale (GCS) < 15; and positive result on focused assessment with sonography for trauma (FAST) scan. For sensitivity analysis, we assessed age-adjusted ped-ABC scores using cut-off points for different ages. Results In total, 540 patients had transfusion within 24 hours after trauma among the eligible 5,943 pediatric patients with trauma. The in-hospital mortality rate was 2.6% (145/5,615). Transfusion increased from 7.6% (430/5,631) to 35.3% (110/312) in patients with systolic blood pressure ≤ 90 mmHg (1 point); from 6.1% (276/4,504) to 18.3% (264/1,439) for heart rate ≥ 120/min (1 point); from 4.1% (130/3,198) to 14.9% (410/2,745) for disturbance of consciousness with GCS < 15 (1 point); and from 7.4% (400/5,380) to 24.9% (140/563) for FAST positivity (1 point). The ped-ABC score of 0, 1, 2, 3, and 4 points were associated with the transfusion rates of 2.2% (48/2,210), 7.5% (198/2,628), 19.8% (181/912), 53.3% (88/165), and 89.3% (25/28), respectively. After age adjustment, c-statistic was 0.76 (95% CI, 0.74–0.78). Conclusions The ped-ABC score using the vital signs and FAST may be helpful in predicting the transfusion requirements within 24 hours for children with trauma.

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Association of Prehospital Transfusion With Mortality in Pediatric Trauma

et al. 2023

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ImportanceOptimal hemostatic resuscitation in pediatric trauma is not well defined.ObjectiveTo assess the association of prehospital blood transfusion (PHT) with outcomes in injured children.Design, Setting, and ParticipantsThis retrospective cohort study of the Pennsylvania Trauma Systems Foundation database included children aged 0 to 17 years old who received a PHT or emergency department blood transfusion (EDT) from January 2009 and December 2019. Interfacility transfers and isolated burn mechanism were excluded. Analysis took place between November 2022 and January 2023.ExposureReceipt of a blood product transfusion in the prehospital setting compared with the emergency department.Main Outcomes and MeasuresThe primary outcome was 24-hour mortality. A 3:1 propensity score match was developed balancing for age, injury mechanism, shock index, and prehospital Glasgow Comma Scale score. A mixed-effects logistic regression was performed in the matched cohort further accounting for patient sex, Injury Severity Score, insurance status, and potential center-level heterogeneity. Secondary outcomes included in-hospital mortality and complications.ResultsOf 559 children included, 70 (13%) received prehospital transfusions. In the unmatched cohort, the PHT and EDT groups had comparable age (median [IQR], 47 [9-16] vs 14 [9-17] years), sex (46 [66%] vs 337 [69%] were male), and insurance status (42 [60%] vs 245 [50%]). The PHT group had higher rates of shock (39 [55%] vs 204 [42%]) and blunt trauma mechanism (57 [81%] vs 277 [57%]) and lower median (IQR) Injury Severity Score (14 [5-29] vs 25 [16-36]). Propensity matching resulted in a weighted cohort of 207 children, including 68 of 70 recipients of PHT, and produced well-balanced groups. Both 24-hour (11 [16%] vs 38 [27%]) and in-hospital mortality (14 [21%] vs 44 [32%]) were lower in the PHT cohort compared with the EDT cohort, respectively; there was no difference in in-hospital complications. Mixed-effects logistic regression in the postmatched group adjusting for the confounders listed above found PHT was associated with a significant reduction in 24-hour (adjusted odds ratio, 0.46; 95% CI, 0.23-0.91) and in-hospital mortality (adjusted odds ratio, 0.51; 95% CI, 0.27-0.97) compared with EDT. The number needed to transfuse in the prehospital setting to save 1 child’s life was 5 (95% CI, 3-10).Conclusions and RelevanceIn this study, prehospital transfusion was associated with lower rates of mortality compared with transfusion on arrival to the emergency department, suggesting bleeding pediatric patients may benefit from early hemostatic resuscitation. Further prospective studies are warranted. Although the logistics of prehospital blood product programs are complex, strategies to shift hemostatic resuscitation toward the immediate postinjury period should be pursued.

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Validation of the age-adjusted shock index using pediatric trauma quality improvement program data

Cited by 68 publications

References 10 publications

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

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

Assessment of Blood Consumption score for pediatrics (ped-ABC score) predicts transfusion requirements for children with trauma.

Association of Prehospital Transfusion With Mortality in Pediatric Trauma

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