Maria E Linnaus1, David M Notrica2, Crystal S Langlais1, Shawn D St Peter3, Charles M Leys4, Daniel J Ostlie5, R Todd Maxson6, Todd Ponsky7, David W Tuggle8, James W Eubanks9, Amina Bhatia10, Adam C Alder11, Cynthia Greenwell11, Nilda M Garcia8, Karla A Lawson8, Prasenjeet Motghare12, Robert W Letton12. 1. Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016, USA. 2. Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016, USA. Electronic address: dnotrica@phoenixchildrens.com. 3. Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA. 4. American Family Children's Hospital, 1675 Highland Ave, Madison, WI 53792, USA. 5. Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016, USA; American Family Children's Hospital, 1675 Highland Ave, Madison, WI 53792, USA. 6. Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR 72202, USA. 7. Akron Children's Hospital, 1 Perkins Sq, Akron, OH 44308, USA. 8. Dell Children's Medical Center, 4900 Mueller Blvd, Austin, TX 78723, USA. 9. LeBonheur Children's Hospital, 50 N Dunlap St, Memphis, TN 38103, USA. 10. Children's Healthcare of Atlanta, 1975 Century Blvd NE#6, Atlanta, GA 30345, USA. 11. Children's Medical Center Dallas, part of Children's Health(SM), 1935 Medical District Dr, Dallas, TX 75235, USA. 12. The Children's Hospital at OU Medical Center, 940 NE 13th St, #1b1306, Oklahoma City, OK 73104, USA.
Abstract
BACKGROUND: Age-adjusted pediatric shock index (SIPA) does not require knowledge of age-adjusted blood pressure norms, yet correlates with mortality, serious injury, and need for transfusion in trauma. No prospective studies support its validity. METHODS: A multicenter prospective observational study of patients 4-16years presenting April 2013-January 2016 with blunt liver and/or spleen injury (BLSI). SIPA (maximum heart rate/minimum systolic blood pressure) thresholds of >1.22, >1.0, and >0.9 in the emergency department were used for 4-6, 7-12 and 13-16year-olds, respectively. Patients with ISS ≤15 were excluded to conform to the original paper. Discrimination outcomes were compared between SIPA and shock index (SI). RESULTS: Of 1008 patients, 386 met inclusion. SI was elevated in 321, and SIPA elevated in 282. The percentage of patients with elevated index (SI or SIPA) and blood transfusion within 24 hours (30% vs 34%), BLSI grade ≥3 requiring transfusion (28% vs 32%), operative intervention (14% vs 16%) and ICU admission (64% vs 67%) was higher in the SIPA group. CONCLUSION: SIPA was validated in this multi-institutional prospective study and identified a higher percentage of children requiring additional resources than SI in BLSI patients. SIPA may be useful for determining necessary resources for injured patients with BLSI. LEVEL OF EVIDENCE: Level II prognosis.
BACKGROUND: Age-adjusted pediatric shock index (SIPA) does not require knowledge of age-adjusted blood pressure norms, yet correlates with mortality, serious injury, and need for transfusion in trauma. No prospective studies support its validity. METHODS: A multicenter prospective observational study of patients 4-16years presenting April 2013-January 2016 with blunt liver and/or spleen injury (BLSI). SIPA (maximum heart rate/minimum systolic blood pressure) thresholds of >1.22, >1.0, and >0.9 in the emergency department were used for 4-6, 7-12 and 13-16year-olds, respectively. Patients with ISS ≤15 were excluded to conform to the original paper. Discrimination outcomes were compared between SIPA and shock index (SI). RESULTS: Of 1008 patients, 386 met inclusion. SI was elevated in 321, and SIPA elevated in 282. The percentage of patients with elevated index (SI or SIPA) and blood transfusion within 24 hours (30% vs 34%), BLSI grade ≥3 requiring transfusion (28% vs 32%), operative intervention (14% vs 16%) and ICU admission (64% vs 67%) was higher in the SIPA group. CONCLUSION:SIPA was validated in this multi-institutional prospective study and identified a higher percentage of children requiring additional resources than SI in BLSI patients. SIPA may be useful for determining necessary resources for injured patients with BLSI. LEVEL OF EVIDENCE: Level II prognosis.
Authors: Emily C Alberto; Elise McKenna; Michael J Amberson; Jun Tashiro; Katie Donnelly; Arunachalam A Thenappan; Peyton E Tempel; Adesh S Ranganna; Susan Keller; Ivan Marsic; Aleksandra Sarcevic; Karen J O'Connell; Randall S Burd Journal: Injury Date: 2021-06-24 Impact factor: 2.687
Authors: Nienke N Hagedoorn; Joany M Zachariasse; Dorine Borensztajn; Elise Adriaansens; Ulrich von Both; Enitan D Carrol; Irini Eleftheriou; Marieke Emonts; Michiel van der Flier; Ronald de Groot; Jethro Adam Herberg; Benno Kohlmaier; Emma Lim; Ian Maconochie; Federico Martinón-Torres; Ruud Gerard Nijman; Marko Pokorn; Irene Rivero-Calle; Maria Tsolia; Dace Zavadska; Werner Zenz; Michael Levin; Clementien Vermont; Henriette A Moll Journal: Arch Dis Child Date: 2021-06-22 Impact factor: 3.791