Jonathan Strutt1, Andrew Flood2, Anupam B Kharbanda1. 1. From the Departments of Pediatric Emergency Medicine and. 2. Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN.
Abstract
OBJECTIVES: Compared with unadjusted shock index (SI) (heart rate/systolic blood pressure), age-adjusted SI improves identification of negative outcomes after injury in pediatric patients. We aimed to further evaluate the utility of age-adjusted SI to predict negative outcomes in pediatric trauma. METHODS: We performed an analysis of patients younger than 15 years using the National Trauma Data Bank. Elevated SI was defined as high normal heart rate divided by low-normal blood pressure for age. Our primary outcome measure was mortality. Secondary outcomes included need for a blood transfusion, ventilation, any operating room/interventional radiology procedures, and intensive care unit stay. Multiple logistic regressions were performed. RESULTS: Twenty-eight thousand seven hundred forty-one cases met the study criteria. The overall mortality rate was 0.7%, and 1.7% had an elevated SI. Patients with an elevated SI were more likely (P < 0.001) to require blood transfusion, ventilation, an operating room/interventional radiology procedure, or an intensive care unit stay. An elevated SI was the strongest predictor for mortality (odds ratio [OR] 22.0) in pediatric trauma patients compared with hypotension (OR, 12.6) and tachycardia (OR, 2.6). CONCLUSIONS: Elevated SI is an accurate and specific predictor of morbidity and mortality in pediatric trauma patients and is superior to tachycardia or hypotension alone for predicting mortality.
OBJECTIVES: Compared with unadjusted shock index (SI) (heart rate/systolic blood pressure), age-adjusted SI improves identification of negative outcomes after injury in pediatric patients. We aimed to further evaluate the utility of age-adjusted SI to predict negative outcomes in pediatric trauma. METHODS: We performed an analysis of patients younger than 15 years using the National Trauma Data Bank. Elevated SI was defined as high normal heart rate divided by low-normal blood pressure for age. Our primary outcome measure was mortality. Secondary outcomes included need for a blood transfusion, ventilation, any operating room/interventional radiology procedures, and intensive care unit stay. Multiple logistic regressions were performed. RESULTS: Twenty-eight thousand seven hundred forty-one cases met the study criteria. The overall mortality rate was 0.7%, and 1.7% had an elevated SI. Patients with an elevated SI were more likely (P < 0.001) to require blood transfusion, ventilation, an operating room/interventional radiology procedure, or an intensive care unit stay. An elevated SI was the strongest predictor for mortality (odds ratio [OR] 22.0) in pediatric traumapatients compared with hypotension (OR, 12.6) and tachycardia (OR, 2.6). CONCLUSIONS:Elevated SI is an accurate and specific predictor of morbidity and mortality in pediatric traumapatients and is superior to tachycardia or hypotension alone for predicting mortality.
Authors: Craig D Newgard; Peter E Fischer; Mark Gestring; Holly N Michaels; Gregory J Jurkovich; E Brooke Lerner; Mary E Fallat; Theodore R Delbridge; Joshua B Brown; Eileen M Bulger Journal: J Trauma Acute Care Surg Date: 2022-04-27 Impact factor: 3.697
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